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OUR  NATION'S  HEALTH  ENDANGERED 
BY  POISONOUS  INFECTION 

THROUGH  THE 

SOCIAL  MALADY 

THE  PROTECTIVE  WORK 
OF  THE 

MUNICIPAL  CLINIC  OF  SAN  FRANCISCO 

AND  ITS  FIGHT  FOR 

EXISTENCE 


BY 

DR.  JULIUS  ROSENSTIRN, 

Chief  of  Staff  and  Attending  Surgeon  Mount  Zion  Hospital; 

Chairman  Advisory  Committee  Municipal  Clinic. 

SAN  FRANCISCO 

1913 


Printed  by  Thk  Town  Talk  Press 
San  Francisco.  Cal. 


9574N 


\-,q 
12.5 

a5R7 
PREFACE 


This  publication  is  issued  for  a  tzi'ofold  purpose. 

It  is  a  public  denouncemeut  of  an  uin^'arrantable  ivrong  done 
in  this  city  by  the  suppression  of  an  institution  that  has  been  niost 
active  for  the  benefit  and  preservation  of  the  public  health. 

This  institution,  the  Municipal  Clinic  of  San  Francisco,  a 
pioneer  in  its  aims  and  system,  has  made  a  truly  successful  effort 
tozcard  a  solution  of  the  ever  present  problem  of  the  social  malady, 
prostitution,  and  tozcard  minimizing  its  resulting  injuries. 

The  zvave  of  a  frantic  and  reckless  so-called  moral'  purity 
Reform  movement,  zvhich  has  temporarily  destroyed  the  good 
zi'ork  of  the  Municipal  Clinic,  is  inundating  the  entire  country 
and  foreshadozvs  stricggles  sijiiilar  to  the  one  fought  here. 

Efforts  elsezt'here  of  the  character  of  the  Municipal  Clinic,  to 
check  the  terrible  spread  of  venereal  disease,  zvill  meet  zvith  the 
same  mode  of  opposition  by  the  same  kind  of  people  zcho  are 
responsible  for  the  harm  done  here.  The  same  pious  prudery  zvill 
voice  its  horror,  the  same  tactics,  the  same  political  pressure  zvill 
be  used  to  suppress  or  retard  the  good  zcork. 

I  am  divulging  the  plan  of  attack  of  the  opponents  of  sanitary 
reforms  of  the  social  malady,  and  offer  some  of  the  zveapons 
which  in  time  zvill  surely  bring  victory  to  the  banner  of  Social 
Hygiene. 

I  sincerely  hope  these  pages  zcill  aid  in  defeating  tJie  reaction- 
ary measures  of  those  zvho  zvorship  at  the  shrine  of  shattered 
antiquated  idols,  and  zvho  are  offering  as  a  sacrifice,  the  Natio)i's 

health. 

Julius  Rosenstirn. 

San  Francisco,  September,  ipi^. 


Copyright,   1913 

By 

DR.   JULIUS    ROSENSTIRN 


OUR  NATION'S  HEALTH  ENDANGERED 
BY  POISONOUS  INFECTION 

THROUGH  THE 

SOCIAL  MALADY 

THE   PROTECTIVE  V/ORK   OF  THE 

MUNICIPAL  CLINIC  OF  SAN  FRANCISCO 
AND  ITS  FIGHT  FOR  EXISTENCE 

BY 

DR.    JULIUS    ROSENSTIRN, 

Chief  of  Staff  and  Attending  Surgeon  Mount  Zion  Hospital; 

Chairman  Advisory  Committee  Municipal  Clinic. 


These  pages  are  written  for  men  and  women.  Read  them 
with  a  mind  free  from  prejudice,  and  with  a  spirit  not  shrink- 
ing from  a  full,  clear  and  unminced  discussion  of  the  most 
important  sanitary  problem  of  the  hour,  the  SOCIAL 
MALADY— PROSTITUTION. 

Among  the  American  people  there  has  always  been  a  most 
stubborn  opposition  to  the  free  discussion  of  this  burning 
question.  The  taboo  that  educators  have  put  on  the  theme  of 
sex  relation,  on  a  thorough  instruction  in  the  origin  of  human 
life  and  its  procreation,  has  resulted  in  the  profoundest  ignor- 
ance among  the  laity  of  these  most  vital  matters.  Not  only  the 
young,  who  are  carefully  kept  in  complete  darkness,  but  the 
great  masses  of  people,  grown-ups  and  old,  have  at  best  but 
a  vague  and  hazy  conception  of  conditions,  the  knowledge  of 
which  is  far  more  essential  to  their  happiness  than  familiarity 
with  the  geography  of  Asia  or  even  the  history  of  the  L^nited 
States.  Instead  of  arming  the  young  with  the  clean  and  sharp 
weapon  of  knowledge,  they  are  permitted  to  enter  the  battle 
of  life  with  its  temptations  and  pitfalls,  ignorant  of  all  its  most 
vital  constructive  and  destructive  conditions,  or  they  are  at 
best  merely  provided  with  scraps  of  misinformation  snatched 
from  the  gutter. 

And  the  good,  oh  so  good,  people,  indulge  in  speeches  de- 
ploring the  depraved  morality,  the  downfall  of  the  present 
generation.  Tears  are  shed  mourning  over  lost  souls  and 
ruined  bodies;  but  all  this  emotional  display  is  obscured  by 
mysteriously  veiled  language,  that  the  new  young  who  come 
after  the  lost  ones,  who  form  the  fresh  clean  ranks  replacing 


tlitisc  ilociiiKitoil  hy  imi< uaiut',  ma\    imt  Icani,  may  not  know  ; 
may  not  have  the  only  protcctit*!!  that  counts — knovvlcdi^c. 

Ilca\cn  l\trbi(l  that  anyone  slionld  discuss  such  matters 
pul)Iicly  and  freely  ;  it  mij^ht  afTect  the  pure, — open  their  eyes 
perchance — it  mij^ht  injure  tlie  hHnd  to  i^ive  them  sig^ht ! 

Do  these  same  .i;i)od  people  really  believe  they  can  sale- 
jjuard  the  fiercely  dominant  sex-call  of  awakening  youth  with 
mild  and  vas;ue  precepts?  Cage  tiie  monarch  of  the  jungle 
hehiml  moscpiito  bars  and  rejoice  in  the  safety  it  guarantees? 

lUit  these  good  people  declare  that  the  public  does  not  want 
to  hear  about  the  social  malady,  about  prostitution  and  its 
dreadful  consequences  in  the  spread  of  loathsome  diseases. 

That  is  not  true.  The  public,  the  great  mass  of  the  people, 
are  always  eager  to  gain  knowledge  of  conditions  for  the 
preservation  of  their  health  and  happiness.  But  they  are  ig- 
norant, i^itiably  ignorant.  Tell  them  of  the  dangers,  of  the 
terrible  ravages  due  to  \  enereal  diseases,  tell  them  that  80 
per  cent  of  all  deaths  from  inflammatory  diseases  peculiar  to 
women,  the  necessity  for  7S  per  cent  of  all  gynecological 
operations  and  for  more  than  60  per  cent  of  all  that  kind  of 
medical  work  is  due  to  these  infections.  Let  them  know  that  up  to 
a  few  years  ago,  before  the  Crede  prophylactic  eye-treatment 
was  generalized  in  Germany,  and  even  now  where  it  has  not 
been  adopted.  80  per  cent  of  disastrous  inflammation  of  the 
eyes  (ophthalmia)  and  20  to  25  per  cent  of  all  blindness  has 
been  caused  by  gonorrhoeal  infection,  chiefly  due  to  the  passing 
of  the  new-born  babe  through  the  diseased  maternal  genitals. 
Tell  them  that  about  80  per  cent  of  syphilis-infected  children 
die  in  their  mothers'  wombs,  and  the  20  per  cent  living  carry 
w^ith  them  the  lifelong  marks  and  defects  of  mind  and  body 
as  their  heirloom,  transmissible  again  to  their  offspring.  Add 
to  that  the  recital  of  the  efTects  of  acquired  syphilis,  its  de- 
structive work  on  the  vital  organs,  its  causation  of  paralysis, 
locomotor  ataxia,  insanity  combined  with  the  unceasing  appre- 
hension of  Damocles'  sword  during  the  victim's  lifetime. 

Our  institutions  for  the  feeble  minded,  our  insane  asylums,  both 
filled  to  overflowing,  draw  their  largest  percentage  of  inmates 
from  the  victims  of  acquired  or  inherited  syphilis.  All  these 
unfortunates,  sheltered  in  public  places  of  refuge,  constitute 
only  a  fraction  of  the  stricken  ones;  the  far  greater  number  are 
kept  cautiously  guarded  from  the  public  eye  under  private  care. 
.  Let  the  public  know  that  gonorrhoea,  considered  by  them 
a  slight,  if  not  a  negligible  disease,  is  the  cause  of  untold  suf- 
fering to  wives  infected  by  their  incompletely  cured,  inno- 
cently   ignorant,    young   husbands,    finally    resulting    in    their 

8 


becoming  unhappy  matrons  of  childless  homes.  Tell  the  pub- 
lic that  the  individuals  infected  with  these  venereal  diseases 
far  outnumber  the  sufferers  from  all  the  other  infectious  dis- 
eases combined:  that  a  moderate  estimate  from  the  pen  of 
Dr.  Adolphus  Knopff  (Professor  of  Medicine  in  the  New  York 
Post  Graduate  Medical  School  and  Hospital,  and  Director  of 
the  New  York  Health  Department  Clinics),  for  that  great  city 
alone  reaches  200.000  syphilitic,  and  800,000  gonorrhoeal,  or  a 
total  of  1,000,000  venereally  infected  individuals.  A  later 
statement  made  only  a  few  weeks  ago  by  the  eminent  British  army 
surgeon,  Major  H.  A.  French,  before  the  International  Medical 
Congress  in  London  last  July  ( 1913)  gave  the  number  of  sufferers 
from  syphilis  in  Paris  as  17  out  of  every  100  men.  New  York 
exceeds  this,  having  over  20  per  hundred  or  one  out  of  ever}^ 
five.  And  let  them  hear  that  part  of  the  last  annual  report 
of  Secretary  of  War  Stimson,  wherein  he  says : 

"The  high  percentage  of  venereal  disease  continues  to  be  the 
reproach  of  the  American  army,  and  the  daily  average  number  of 
those  sick  from  that  cause  during  the  past  calendar  year  was  larger 
than  the  daily  number  of  those  sick  from  all  other  of  the  more  im- 
portant  diseases   combined." 

The  figures  as  given  by  the  Surgeon-General  for  diff'erent 
armies  emphasize  this  statement.  The  percentages  of  venereal 
diseases  are:  in  the  British  army,  7.6;  in  Austria-Hungary,  5.4; 
in  Prussia,  1.9;  in  the  United  States,  19.7. 

"I  believe,"  continues  Secretary  Stimson,  "that  the  ultimate 
causes  which  make  the  record  of  our  army  in  this  respect  shameful 
beyond  that  of  the  army  of  any  other  civilized  nation,  are  inherent 
in  our  own  shortcomings  as  a  nation  in  dealing  with  this  matter. 
So  long  as  in  our  civil  communities,  and  particularly  our  larger  cities, 
we  continue  to  close  our  eyes  to  the  magnitude  and  extent  of  the 
evil  and  refrain  from  attacking  it  with  all  of  the  weapons  which 
modern  scientific  knowledge  places  in  our  hands,  it  cannot  but  be 
expected  that  the  younger  men  in  our  army,  leading  the  abnormal 
life  of  the  soldier,  will  show  the  effect  of  the  evil  to  a  marked  degree." 

After  all  this  has  been  said  to  our  general  public,  does 
anyone  believe  the  people  will  still  be  adverse  to  a  free  and 
open  discussion?  Or  is  it  not  more  likely  that  from  all  quar- 
ters a  great  cry  will  arise  demanding  light  for  all  the  dark 
corners — a  cry  for  protection — for  relief  from  this  devouring 
monster  Minotaur? 

Investigations  of  red  light  conditions  of  a  most  serious 
and  far-reaching  nature  have  recently  been  carried  on  more 
or  less  simultaneously  in  numerous  large  cities  of  the  Ignited 
States.  \''ice  commissions  voice  their  rightful  indignation  at 
the  existence  of  a  white  slave  traflfic  flourishing  under  the  very 
eyes  of  official  authority,  with  those  eyes  closing  at  convenient 
intervals.      These   commissioners   have   not   stopped    at    mere 


plaintive  coiniiKiits.  The}-  appidaclicd  this  task  uiiprci)areil 
t\)r  what  it  would  reveal,  i.mioram  ••!  tlu'  \  ast  extent  of  the 
tioUl  thev  had  to  cover;  ignorant  ui  tlic  many  and  widespread 
rainitications  their  work  disclosed.  They  were  good  men,  all  of 
them.  They  were  deeply  and  profoundly  shocked.  And  from  the 
vitilence  of  their  reaction  from  this  shock  there  emerged  a  code  of 
laws,  a  series  of  e^licts.  to  legislate  sex-virtue  to  mankind;  to  dic- 
tate ahstemious  purity,  to  su])press  prostitution  and  persecute  its 
votaries. 

All  this  cant  about  the  iminirit}-  ul  the  sexual  act  sounds 
like  blasphemy.  As  the  ultimate  expression  of  the  loftiest 
sentiment  that  moves  the  heart  of  humanity,  the  ecstasy  of  its 
emotions  lends  inspiration  for  the  most  beautiful  works  of  art 
by  sculptors  and  painters,  poets  and  musicians.  If  anything 
is  really  impure  in  itself  can  a  few  words  uttered  by  an  official 
oi  state  or  church  render  it  pure  and  holy?  Is  there  any  sense 
in  the  laws  of  some  of  our  states  making  the  sexual  act  of 
unmarried  individuals  a  punishable  crime,  while  sanctifying 
it  with  a  license  issued  by  either  state  or  church? 

On  physiological  grounds  the  necessity  of  the  sexual  act 
for  the  preservation  of  the  individual's  health  has  been  dis- 
puted. 

The  greatest  nerve  specialists  of  the  day,  Professor  Freud 
of  Vienna,  and  the  followers  of  the  modern  school  of 
phsychiaters  and  neurologists,  claim  on  pathological  grounds, 
and  give  satisfactory  proofs,  that  many  grave  disorders  of  the 
nervous  system  are  caused  by  the  suppression  of  sex  desire. 

But  does  the  belief  or  unbelief  in  the  dire  necessity  of 
sexual  intercourse  really  decide  anything?  Or  is  not  the  only 
important  essential  fact  best  stated  in  the  words  of  Havelock 
Ellis*,  the  greatest  authority  on  matters  relating  to  sexual 
relationship?  "Love  and  hunger  are  the  foundations  of  life, 
and  the  impulse  of  sex  is  just  as  fundamental  as  the  impulse 
of  nutrition.  It  wmII  not  remain  absent  because  we  refuse  to 
call  for  its  presence ;  it  will  not  depart  because  we  find  its 
presence  inconvenient.  At  the  most  it  will  only  change  its 
shape,  and  mock  at  us  from  beneath  masks  so  degraded,  and  some- 
times so  exalted,  that  we  are  not  longer  able  to  recognize  it." 
etc..  etc. 

It  is  needless  to  add  that  application  of  the  oft  proposed 
remedy  of  early  marriage  is  as  impossible  for  the  great 
majority  of  laboring  men  as  following  an  advice  to  loaf  at  the 
Riviera    for    the    impecunious    tuberculous    patient.      Fortunate 


*  Havelock    Ellis,   The   Task   of   Social    Hygiene,    1912,    p.    255-6. 

10 


these  laborers  are,  if  they  earn  enough  throughout  the  year  to 
support  themselves  decently. 

Here,  free  love  or,  where  circumstances  prevent  this,  pros- 
titution offers  the  substitute  wife,  and  it  is  prostitution  only 
that  stamps  the  sexual  intercourse  with  impurity.  The  com- 
mercialization of  an  act,  that  should  be  the  last  and  highest 
consummation  of  mutual  affection,  is  to  all  our  better  instincts 
revolting  and  abhorrent. 

If  the  suppression  of  sex  desire  and  abstinence  from  its 
gratification  cannot  be  generally  enforced  by  legal  or  other 
methods,  how  about  the  present  effort  to  persecute  and  sup- 
press prostitution  by  the  enactment  and  enforcing  of  laws? 
These  investigators  of  the  social  malady  question  could  not 
have  been  ignorant  of  its  history.  They  must  have  known 
that  Europe  for  many  centuries  had  enacted  and  enforced 
similar  and  much  more  cruel  laws,  imprisoning,  banishing, 
maiming,  flogging,  nay,  even  killing  prostitutes  and  their  allies, 
up  to  the  time  and  during  the  reign  of  Maria  Theresia  of 
Austria. 

And  in  spite  of  all  the  laws  similar  to,  and  severer  than  ours 
that  have  been  written,  enacted  and  enforced,  in  spite  of  most 
cruel  punishments  inflicted,  the  social  malady  has  remained 
with  us  since  time  immemorial  and  is  as  widespread  today, 
secretly  and  openly,  as  at  any  time  in  the  world's  history.  The 
social  malady  remains  the  most  ancient  cancer  of  society ;  it 
does  not  stop  at  the  moral  and  physical  corruption  of  its  own 
votaries,  but  carries  germs  of  loathsome  diseases  along  diverse 
channels  and  secret  pathways,  permeating  the  social  structure 
in  all  directions.  From  the  house  of  shame  these  germs  are 
carried  to  the  trusting  helpmate  of  the  home  and  to  its  innocent 
blessing  in  the  cradle,  turning  it  into  a  curse. 

Can  we  legislate  people  to  become  deaf  to  the  passionate 
call  of  sex?  Do  the  laws  stuff  cotton  into  the  ears  of  men 
and  women,  as  Ulysses  put  Avax  into  the  ears  of  his  crew  when 
his  ship  passed  the  isle  of  the  sweet  singing  sirens? 

We,  in  the  United  States  of  America,  have  preserved 
through  centuries  of  progress  along  other  lines,  antiquated 
criminal  laws  in  a  moral  code  of  puritan  manufacture.  They 
have  long  been  abandoned  or  ignored  by  the  other  civilized 
nations,  but  enjoy  perennial  bloom  in  this  countr3^  These 
laws  have  not  helped  to  improve  our  morals  and  they  cer- 
tainly fail  to  enlist  a  higher  respect  abroad. 

Havelock  Ellis*  says  with  reference  to  tliis:     "F^aws  and 

*  Op.    cit.,    p.    281. 

11 


rejjulations  of  the  incilic\al  kind,  idi"  tlii'  moral  (irdcrin;^  of  the 
-niallost  ilctails  i>f  life,  arc  still  enacted  in  America,  but  they 
irc  rciianlcd  with  i^rowiiij;-  contempt  by  the  community  and 
even  by  the  administrators  of  the  laws.  It  is  realized  that 
>uch  minute  inijuisition  into  the  citizen's  ])rivate  life  can  only 
be  ctTectively  carried  out  where  the  citizen  himself  recognizes 
the  divine  ri.ijht  t)f  the  inquisitor.  Hut  the  theocratic  conception 
of  life  tio  lonj^er  corresponds  to  American  ideas  or  American 
customs;  this  minute  moral  le.y,islation  rests  on  a  basis  which 
in  the  course  of  centuries  has  become  rotten.  Thus  it  has 
come  about  that  nowhere  in  the  world  is  there  so  j^reat  an 
anxiety  to  place  the  moral  ret^ulation  of  social  afTairs  in  the 
hands  of  the  police;  nowhere  are  the  police  more  incapable  of 
carryinc^  out  such  regulation." 

And  furthert :  "A  sudden  impulse  seizes  on  a  community 
and  spreads  to  other  communities  to  attempt  to  suppress  some 
form  of  immorality  by  law.  Such  attempts,  as  we  know,  have 
always  ended  in  failure  or  worse  than  failure,  for  laws  against 
morality  are  either  not  carried  out,  or,  if  they  are  carried  out, 
it  is  at  once  realized  that  new^  evils  are  created  worse  than  the 
original  evils,  and  the  laws  speedily  fall  into  abeyance  or  are 
repealed.  That  has  been  repeatedly  seen  and  is  well  illustrated 
by  the  history  of  prostitution,  a  sexual  manifestation  which 
for  two  thousand  years  all  sorts  of  persons  in  authority  have 
sought  to  suppress  ofT-hand  by  law  or  by  administrative  fiat." 

To  illustrate  the  working  of  some  of  these  laws,  let  me 
mention  a  law  against  adultery  passed  in  New  York  State  in 
1907  and  rendering  any  person  convicted  of  adultery  liable 
to  be  punished  by  six  months'  imprisonment,  a  heavy  fine,  or 
both.  The  National  Christian  League  for  the  Promotion  of 
Puritv  was  responsible  for  the  enactment  of  this  law,  which 
was  intended  to  prevent  adultery.  The  law  became  a  dead 
letter  less  than  three  months  after  its  enactment,  and  in  the 
two  years  following  only  three  persons,  under  this  act.  were 
sent  to  prison  for  a  few  days  and  only  four  fined  a  small  sum. 

The  Committee  of  Fourteen  in  New  York  City  stated:  "It 
is  of  practically  no  efifect,"  adding,  "The  preventive  values  of 
this  statute  cannot  be  determined,  but  judging  from  the  prose- 
cutions, it  has  proved  an  ineffective  w^eapon  against  immorality 
and  has  practically  no  efifect  upon  commercialized  vice."* 

I'pon  an  infjuiry  into  the  state  of  red  light  conditions  in 
cities    with    a    poj)ulation    of    25.000    and    over,    tliroughout    the 


p.    284. 

The  Social   Evil   in   Xew    Vork  City.   i>.    100. 

12 


country,  the  ^^lunicipal  Clinic  received  answers  from  ninety 
cities,  showing  the  inefficiency  of  restrictive  laws. 

Answers  were  requested  to  questions  regarding"  the  preva- 
lence of  the  social  malady,  the  attitude  of  the  authorities  toward 
its  toleration  or  suppression,  and  the  ensuing  result  as  to  its 
presence  or  absence  in  their  community,  with  its  effect  upon 
the  distribution  of  specific  diseases,  and  the  state  of  local 
opinion. 

This  collection  of  answers  to  our  queries  is  a  sadly  con- 
firming commentary  on  our  views  regarding  the  effect  of  a 
relentless  persecution. 

I  shall  only  quote  here  Iowa,  as  the  pioneer  state  for 
strictest  suppression.  The  legislature"  of  Iowa  passed  the 
severest  ^restrictive  laws  (October,  1908).  and  from  a  com- 
parison of  the  three  answers  from  three  different  Iowa  towns 
to  our  questions,  one  easily  perceives  which  one  of  the  three 
officials  states  the  true  condition  of  affairs,  and  the  attempt  of 
the  others  to  paint  with  rose-colored  tints. 


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nur  own  sister  t«'\\n,  I.ns  Aul^cIcs.  has  tried  stern  rcpros- 
si\e  measures  ami  the  sail  results  are  (tul\-  too  well  known. 
\\  itli  the  enforcement  of  pcrsecutinj;  laws,  and  upon  the 
closure  <*\  their  tolerated  iiouses  of  prostitution,  the  inmates 
scattereil  all  over  the  various  city  districts.  Residential  and 
business  parts  became  alike  infested  with  the  presence  of 
prostitutes.  Street  walkers  multiplied  and  reports  of  scandals 
of  the  worst  character,  in  the  city  and  its  siuToiuKling'  suburbs, 
filled  the  air  and  the  colunms  of  the  public  press.  Worse  than 
all.  an  era  of  spyinjj^  and  blackmailinj.;  has  followed  which 
clouils  the  serenity  of  the  suutheru  sk\-. 

Portland.  Oreg'on.  is  another  of  the  cities  which  have  be- 
come aware  that  means.  difTerent  from  suppression,  and  far 
closer  to  the  root  of  the  social  malady,  must  be  employed  to 
inhibit  prostitution.  The  actin_e^  mayor  of  that  city  authorized 
the  representatives  of  the  Clinic,  in  their  memorable  confer- 
ence before  our  Mayor  Rolph.  to  inform  him  that  the  abolition 
of  re.^^lementation  and  segregation  and  the  enforcement  of 
prohibitory  punitive  measures  had  scattered  the  votaries  of  the  red 
light  districts  all  over  the  city,  and  had  proved  a  lamentable  failure. 
These  examples  could  be  multiplied  indefinitely. 

Recently,  in  New  York,  before  the  investigating  Board  of 
the  Curran  Committee,  Mr.  S.  London,  a  former  District 
Attorney  of  Texas,  stated,  as  a  sworn  witness,  that  he  had 
been  employed  for  seven  years  as  a  government  expert  with 
a  corps  of  sometimes  fifteen  assistants  to  examine  the  white 
slave  traffic  conditions  throughout  the  country  from  Alaska 
to  Florida  and  Maine,  and  gave  as  his  opinion  that  San  Fran- 
cisco ranked  morally  as  one  of  the  very  best  cities  in  the  United 
States,  on  account  of  its  reglementation.  a  measure  which  he 
considered  the  best  means  of  minimizing  the  evils  of  prosti- 
tution. 

Identical  information  from  municipal  bodies  has  come  to  us 
from  all  parts  of  the  country.  These  are  not  the  views  of 
vice  commissions,  professors,  academic  and  moral  theorists, 
but  convictions  acquired  after  long  years  of  daily  contact  with 
this  phase  of  life. 

There  are  very  good  reasons  why  these  repressive  measures 
fail  in  their  purpose. 

Medicine  has  long  ago  recognized  that  the  real  delivery 
from  diseases  in  general,  and  from  filth  and  germ  diseases 
especially,  lies  not  in  the  cure  of  attacked  individuals,  but  in 
the  prevention  of  the  attack.  Formerly  a  fresh  supply  of  newly 
infected    cases    always    replaced    those    who    had    recovered 

16 


through  the  administration  of  drugs.     Thus  the  course  of  the 
epidemic  continued. 

For  centuries  we  have  used  the  properties  of  cinchona,  or 
quinine,  as  the  sovereign  remedy  for  malarial  fevers.  But  only 
since  the  discovery  of  the  transmission  of  these  disease  germs 
through  the  mosquito,  and  the  successful  warfare  against  this 
death-dealing  insect  have  we  achieved  any  real  results  in 
checking  the  spread  of  that  disease. 

We  did  not  create  or  enforce  laws  for  the  people  of  Havana, 
of  Louisiana,  or  the  Canal  Zone,  rendering  them  guilty  of  a 
misdemeanor  or  a  felony  if  stricken  with  malarial  and  yellow 
fevers.  But  we  went  to  work  and  cleaned  up  the  cities,  the 
cesspools,  the  marshes,  spread  oil  over  the  breeding  places  of 
the  infectious  insects — in  short,  gave  them  a  general  house- 
cleaning,  and  we  obtained  results  that  astonished  the  world. 
The  discovery  of  the  relation  of  the  rat  to  the  plague  and  its 
consequent  extermination  is  another  example  of  the  victory 
of  modern  preventive  science. 

The  social  malady  will  offer  the  same  resistance  to  any  sur- 
face scratchings  for  extermination.  Ignorance,  mental  de- 
ficiency, sordid  surroundings,  love  of  finery,  seduction  and 
fraud,  economic  struggles,  sex  desire,  all  combine  to  furnish 
fresh  recruits  for  the  ev^r  renewing  contingent  of  the  red  light 
district.  Is  a  law  against  the  ready-made  prostitute  a  remedy 
for  these  evils?  Will  laws  against  the  houses  that  harbor 
ready-made  prostitutes  eliminate  the  causes  that  created  them? 
Can  laws  stifle  the  most  passionate  desire  that  human  flesh  has 
been  endowed  with?  Can  laws  restrain  young  men  and 
women,  the  mariner  returning  from  the  voyage,  the  miner,  the 
w^oodsman,  the  cowboy,  all  those  who  invade  social  centers 
after  periods  of  isolation ;  can  laws  force  them  to  wear  the 
garb  of  purity  and  grow  the  wings  of  angels? 

Let  us  remedy  the  lack  of  education  for  the  ignorant  and 
the  failing,  the  lack  of  close  guardianship  and  protection  for 
defective  children,  for  the  houseless,  homeless  waifs,  the  off- 
spring of  the  shiftless  and  inebriate,  for  all  those  drifters  to- 
ward the  abyss.  Poor  social  conditions  among  the  great  masses 
of  women  workers,  domestic  and  industrial ;  and  last  but  not 
least,  the  absence  of  sex  education  for  the  young;  these  are 
the  causes  for  the  continuous  recruiting  of  the  ranks  of  pros- 
titution. It  will  not  suffice  to  close  the  brothels,  to  tear  down 
the  shelter  of  the  prostitute,  to  hunt  and  imprison  the  street 
walker.  For  the  RED  PLAGUE  as  well,  we  have  to  exter- 
minate the  mosquitos,  kill  the  rats,  fight   the  causative   ills; 

17 


and  tlic  ills  \\  c  ha\o  to  coikhkt  arc  st>c'ial  untUness,  is^iiorance 
and  poverty. 

Not  io  the  violence  of  revolution,  with  destruction  left  in 
its  path,  but  to  the  work  of  evolution  do  we  look  forward; 
evolution,  mother  of  all  real  progress  in  this  world  of  ours. 
But  the  proj^ress  of  this  work  will  be  slow.  Generations  will 
pass,  will  come  and  pass  as^ain,  before  it  will  be  achieved. 
During:  all  that  time  a  constant  current  of  poison  from  the 
social  malady  will  ceaselessly,,  unrelentingly,  enter  the  body 
of  the  nation,  and  will  penetrate  to  its  very  marrow. 

STOP  IT!  FOR  YOUR  OWX  SAKE,  FOR  YOUR 
CHILDREN'S  SAKE.  FOR  YOl'R  COUNTRY'S  SAKE. 
STOP  IT! 

An  imperative  demand  for  active  sanitary  interference  with 
this  general  pollution  of  all  classes  and  ages  is  urged  by 
modern  hygiene  upon  its  medical  disciples,  leaving  the  task 
of  the  moral  and  sociological  struggle  to  specially  skilled  edu- 
cators and  social  workers. 

The  first  institution  to  carry  out  strictly  sanitary,  scien- 
tific and  humanitarian  methods  was  established  in  this  city 
March.  1911,  and  has  been  in  existence  ever  since,  under  the 
name  of  the  iMUNICIPAL  CLINIC  OF  SAN  FRANCISCO. 

A  short  time  after  the  conflagration  of  April,  1906,  the 
Civic  League  of  Improvement  Club&,  an  association  repre- 
senting all  the  various  improvement  societies  throughout  the 
city,  inspired  by  a  rejuvenated  ambition,  was  founded  to  help 
in  rebuilding,  for  the  old.  a  beautiful  and  modern  sanitary 
city. 

The  Committee  on  Health,  Pure  Food  and  Tenement 
Legislation,  the  chairman  of  which  I  am  honored  to  have  been 
since  the  birth  of  the  League,  soon  recognized  the  importance 
of  its  task.  Directly  after  the  fire,  with  the  general  scattering 
all  over  the  city  of  the  unhoused  prostitutes,  occurred  a  period 
of  unusual  frequency  of  venereal  infections.  We  felt  it  to  be 
one  of  our  first  duties  to  stem  as  far  as  possible  the  inflowing 
tide  of  contaminating  disease  from  the  red  light  votaries. 

In  order  to  be  sufficiently  prepared  for  future  recommenda- 
tions, the  Health  Committee,  together  with  the  Committee  on 
Public  Morals,  through  its  chairman.  Dr.  Frink.  entered  into 
an  extensive  correspondence  with  many  of  the  large  European 
cities  where  regulation  is  practiced,  and  obtained  thorough 
information  on  the  various  systems  in  vogue  there,  which  was 
collected  in  a  voluminous  report.  After  an  unusually  long 
period  of  preliminary  discussion,  extending  over  3^ears,  the 
Board  of  Health  at  last  called  a  meeting  with  my  Committee 

18 


of  the  Civic  League,  a  small  committee  of  representative 
citizens,  including  clergymen  of  various  denominations  and 
members  of  the  State  Board  of  Health,  for  the  purpose  of 
formulating  ways  and  means  for  the  reglementation  of  the 
red  light  district.  Prolonged  deliberations  finally  culminated 
in  the  unanimous  passing  of  resolutions,  which,  recognizing 
the  urgent  necessity  of  measures  for  a  sanitary  regulation  of 
immoral  houses,  called  upon  the  Board  of  Health  to  pass  or- 
dinances for  such  a  purpose. 

In  a  later  joint  session,  a  set  of  ordinances  was  passed  by 
the  Board  of  Health  establishing  the  Municipal  Clinic  under 
the  management  of  an  independent  Advisory  Commission,  to 
consist  of  representatives  of  various  classes  of  citizens  and 
the  President  of  the  Board  of  Health.  Through  changes  in 
the  personnel  of  this  board,  its  president  dropped  out,  and  the 
present  Advisory  Board  is  composed  of  a  lawyer,  Mr.  W.  H. 
Metson;  two  business  men,  Mr.  W.  H.  Ford  and  Mr.  H.  L. 
Morrison ;  a  broad-minded  clergyman.  Father  Wyman ;  the 
Superintendent  of  Public  Schools,  Mr.  Alfred  Roncovieri ; 
and  two  physicians.  Dr.  Martin  Regensberger  and  Dr.  Julius 
Rosenstirn.    (Chairman). 

The  Advisory  Committee  is  non-political,  its  members  at 
present  are  permanent  trustees,  not  subject  to  appointment 
either  by  public  officials  or  by  election,  and  fill  vacancies  or 
add  to  their  number  by  determination  of  the  Commission  itself. 
While  it  must  be  recognized  that  such  an  institution  should 
be  conducted  best  by  the  proper  city  authorities,  this  separation 
from  all  public  officialism  in  the  early  part  of  its  existence  had 
its  great  advantages  and  was  one  of  the  fundamental  condi- 
tions for  its  success.  It  freed  the  Commission  from  all  political 
influence,  and  positions  in  the  service  could  be  given  and  held 
for  merit  only.  If  there  existed  any  graft,  the  Clinic  stopped 
it  effectively.  Financial  independence  was  secured  by  charg- 
ing the  nominal  fee  of  fifty  cents  for  an  examination.  There 
is  a  certain  moral  efifect  connected  with  the  exacting  of  this 
fee,  a  sense  of  self-dependence  is  developed  in  these  women 
and  they  feel  that  the  benefits  derived  from  the  Clinic  are  not 
charity  gifts,  but  paid  for  and  their  proper  right.  From 
this  income  the  Clinic  not  only  defrayed  all  its  expenses  but  a 
surplus  was  accumulating  intended  to  help  in  time  toward  estab- 
lishing an  intermediate  rescue  home  for  girls  who  want  to 
abandon  that  life.  In  cases  of  financial  disability  the  fee  is 
remitted. 

The  Municipal  Clinic  was  opened  in  March,  1911,  and  its 
more  than  two  years  of  active  existence  had  given  promise  of 

19 


c<intimioil  siicocsslul  porfttniiancc  of  the  wiM'k  for  which  it  was 
clcsi»;iicil. 

Tho  city  oriHiianco  uiulcr  which  the  t  linic  operates  exacts 
."lie  examination  every  four  days.  If  the  examination  has 
shown  a  satisfactt>ry  slate  of  health,  a  certificate  to  that  effect 
ensures  freedom  from  petty  harassment,  consequently  there 
shouUl  be  no  reason  for  the  purchase  of  tolerance  or  favors, 
nor  the  necessity  oi  protection  by  a  special  friend. 

The  Clinic  lias  until  lately  liecn  enjoying  the  active  co- 
operation of  the  police  dejiartment ;  and  two  policemen,  care- 
fully selected  for  their  s])ecial  fitness,  were  detailed  for  its  per- 
manent service.  They  made  daily  and  nightly  rounds  of  the 
red  light  district,  prevented  the  infected  bookless  women  from 
plying  their  trade,  and  remanded  the  delinquents  for  clinical 
control. 

For  every  new  client,  a  booklet*  is  prepared  at  the  first  ex- 
amination, which  contains  a  small  photograph  supplied  by  the 
girl,  and  the  records  of  subsequent  examinations.  Votaries  of 
the  red  light  district  without  this  certificate  were  charged  with 
vagrancy  and  brought  before  the  police  judges  who  suspended 
the  sentence  under  order  of  compliance  with  the  sanitary  regula- 
tions of  the  Clinic. 

All  houses  of  the  red  light  district  that  harbored  inmates 
without  this  certificate,  or  with  prolonged  delinquencies,  w'ere 
permanently  closed  after  the  first  warning  had  not  been  heeded, 
and  a  repetition  of  the  offense  detected. 

The  examinations  of  the  Municipal  Clinic  are  thorough, 
being  carried  on  with  all  the  requisites  of  modern  science. 
The  staff  of  the  Clinic  consists  of  a  superintendent,  two  male 
physicians  for  the  examinations,  and  one  female  physician  for 
the  treatment  of  the  clients,  a  bacteriologist,  a  nurse,  a  matron, 
a  cashier  and  stenographer,  a  clerk  and  a  porter.  The  annexed 
plan  will  help  to  illustrate  the  modus  operandi.  It  shows  the 
entrance,  the  first  waiting  room,  the  microscopical  and  bac- 
terio-serological  laboratory,  the  examination  booths,  the  second 
waiting  room,  where  the  women  await  the  result  of  the  micro- 
scopical examination  and  the  exit. 

•  See    Page   22. 


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I'laoli  iicwiy  roi^istorod  j;irl  must  iindor^o  a  s])ccial  l)k)od 
lest  to  ilctormiiie  whctlior  she  is  atilicted  with  a  specific  blood 
disease.  If  ihc  test  proves  distinctly  positive,  even  though  no 
other  synipti>ius  are  present,  two  intravenous  injections  of 
Khrlich's  latest  remedy,  the  new  Salvarsan,  are  given  at  in- 
tervals of  one  week.  If  after  a  varying  period  of  ohservaticMi 
and  regular  after-treatment  no  s\niptonis  aiijiear,  a  booklet 
is  given  to  her  and  she  must  then  ctmform  to  the  connnon 
regulations  of  clinical  inspection. 


^■■H 

Rr,.;.    . 

As-                           -, 

1  li,r    _                               1 
Grn«»!  Byild 
Va.U.M«luo.SMr,? 

1 

s.  r.  M 

iclpal  Clinic  Report  of  Eiamlnalioifl 

■  — 

*-■•-— 

_ 

jJH 

Upon  an  examination  showing  the  client  to  be  suffering 
from  an  infectious  disease  her  booklet  is  taken  away  from  her 
and  she  must  go  into  retirement  and  undergo  medical  treat- 
ment until  pronounced  cured  by  the  doctors  of  the  Clinic.  It 
is  the  client's  privilege  to  employ  her  own  physician  if  she 
chooses,  or  be  treated  by  the  specialist  of  the  Clinic.  In  the 
latter  case  no  fee  is  charged,  the  previous  payment  for  exam- 
ination insuring  gratuitous  treatment  for  specific  illness,  in- 
cluding free  hospital  accommodations,  if  such  are  necessary, 
or  financial  straits  render  self-support  difificult  during  a  longer 
vacation. 

The  patients  are  distributed  among  the  wards  of  the  City 
and  County  Hospital,  but  the  Clinic  pays  the  hospital  charges, 
thereby  also  relieving  its  clients  from  the  objectionable  demon- 
stration before  student  classes.     It  has  been  most  gratifying 

22 


to  note  that  the  number  of  patients  seeking  aid  from  the  Clinic 
has  been  steadily  growing  during  the  last  year,  so  that  only 
a  very  small  percentage  of  our  clients  sought  outside  medical 
attention  when  ill.  Whatever  has  been  their  choice,  a  return 
of  the  booklet  depends  upon  the  result  of  three  or  more  exam- 
inations during  the  course  of  a  week  by  the  chief  clinician ; 
upon  their  satisfactory  outcome  rests  the  permission  for  end- 
ing the  retirement. 

Precautionary  measures  against  any  sort  of  graft  are  amply 
provided  for  in  the  Clinic  itself.     These  cards : 

"THE    FEE    PAID    FOR    EXAMINATION 
IS  THE  ONLY    FEE    THAT    WILL    BE  AC- 
CEPTED    BY    THIS     INSTITUTION.       ANY 
CASES     COMING     FOR     TREATMENT     RE- 
CEIVE   ATTENTION    ABSOLUTELY    FREE 
OF  CHARGE.    NO  GRATUITY  OF  ANY  KIND 
CAN  BE  ACCEPTED  BY  ANY  NURSE,  PHY- 
SICIAN,    OR     ATTENDANT,     UNDER     ANY 
CONSIDERATION     WHATSOEVER.       ANY 
VIOLATION     OF    THIS     RULE     WILL     BE 
PUNISHED  BY  THE    DISCHARGE   OF   THE 
EMPLOYEE    ACCEPTING   THE    GRATUITY 
AND  THE  PENALIZING    OF   THE    PERSON 
GIVING  THE  GRATUITY    BY    WITHHOLD- 
ING THEIR  CERTIFICATE." 
are  placarded  in  every  booth  and  at  various  other  places  in 
the  Clinic  rooms.     The  threat  of  being  deprived  of  the  booklet 
prevents  any  attempt  on  the  part  of  the  clients  to  gain  favor- 
itism.   The  clients  are  called  and  known  to  the  physicians  by 
their   current   number  of   the   day   only,   and   are   continually 
shifted  around ;  moreover,  the  physicians  of  the  Clinic  are,  on 
penalty  of  instant  dismissal,  forbidden  to  attend  any  one  of 
them   in  their  private  practice.     Each  client  receives   a   folder* 
slip  with  a  small  diagram-sketch  of  the  anatomy  of  the  female 
organs  for  her  booklet    giving    brief    instructions    about  the 
various  maladies  to  which  she  is  in  constant  peril  of  being 
exposed.     They  are  urged  to  ask  the  examining  physician  for 
instructions    how    to    protect    themselves    against    infection. 
As  a  further    precaution    for    the    strict    conformance  to  the 
Clinic's   rules   and   for  the  public's  protection,   cards   have  been 
placed   in   all  the  private   rooms   of  these   houses   urging  the 
visitors  to  ask  for  the  booklet  of  the  inmate  and  inspect  the 
date  of  last  examination,  warning  them,  at  the  same  time,  that 
no  complete  protection  against  infection  can  be  assured  under 
existing  conditions. 

•  See    Pajjes   24-25.  23 


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24 


Look  at  and  study  this  lengtuwise  halfcut  (Longitudinal  section), 
through  female  pelvis  with  its  organs,  and  try  to  understand  it. 


ASK  THE  DOCTOR  AT  THE  CLINIC  HOW  TO  MAKE 
PROPER  EXAMINATION  OF  YOUR  VISITORS,  AND  ABOUT 
ANYTHING  ELSE  YOU  DO  NOT  UNDERSTAND;  HE  WILL 
GLADLY  EXPLAIN. 


DO  NOT  FORGET  THAT  THE  MUNICIPAL  CLINIC  IS  YOUR 
FRIEND   AND   FOR  YOUR  OWN   PROTECTION. 


25 


ASK  FOR  THE 
MUNICIPAL  CLINIC  BOOKS 
AND  SEE  THAT  THE    LAST 

EXAMINATION 

HAS  TAKEN  PLACE  WITHIN 

FIVE  DAYS 

PRECEDING  TODAY. 

*The  public  slionld  realize,  however,  that  not- 
withstandincT  the  i;reat  improvement  of  conditions 
throus;h  these  res^^ular  examinations,  no  guarantee 
of  absolute  safety  can  be  assured. 

MUNICIPAL  CLINIC 
682  Commercial  Street. 

This  warning-  has  been  especially  insisted  upon  to  remove 
from  the  visitors'  minds  the  impression  that  the  Clinic  con- 
siders it  possible  that  any  activity  in  this  direction  could  be 
so  complete  as  to  insure  a  perfect  immunity  from  contamina- 
tion. 

And  yet  this  very  precaution  has  been  construed  by  the 
opponents  of  the  Clinic  to  be  an  attractive  encouragement  to 
frequent  these  resorts  as  it  allayed  the  fear  of  infection. 

The  fear  of  disease  is  an  infinitesimally  small  factor  in  pre- 
venting men  from  visiting  prostitutes.  Every  physician  who 
ever  handled  patients  with  these  aflflictions  knows  that  even 
before  complete  recovery  they  are  urging  their  medical  ad- 
viser's consent  to  their  resumption  of  sexual  intercourse. 

If  those  who  have  had  the  experience  and  suffering  from 
an  attack  of  sexual  diseases  do  not  refrain  from  rushing  into 
the  hotbed  of  danger  of  repeated  infection,  how  many  without 
this  still  vivid  memory  of  recent  anguish  will  be  restrained 
by  the  mere  phantom  of  fear?  Even  if  there  should  be  a  few 
isolated  cases  induced  by  reliance  upon  the  Clinic's  examina- 
tions to  visit  the  red  light  district,  are  they  not  far  outweighed 
by  the  numberless  preventions  insured  by  the  added  pre- 
cautionary control  from  this  card? 

Another  objection  has  been  raised  against  the  claim  of 
efficacy  in  the  Clinic's  preventive  sanitary  work.  Our  oppon- 
ents insist  that  no  benefit  can  spring  from  control,  as  no 
matter  in  how  clean  a  state  a  woman  leaves  the  Clinic  after 
her  examination,  she  may  become  infected  within  a  few  hours 
and  be  again  a  source  of  contamination  for  her  visitors.  We 
do  not  deny  that  such  cases  may  and  do  occur,  but  under  this 
system  of  regulation  she  will  have  to  undergo  another  examination 
after  four  days  and  if  diseased  she  will  then  be  stopped.    With  no 

26 


control  she  would  go  on  indefinitely.  We  have  never  claimed 
to  be  able  to  prevent  each  and  every  infection.  We  do  the 
best  possible — no  more  and  no  less. 

So  many  opponents  of  regulation  seem  to  worry  about  an 
apparent  discrimination  against  women,  caused  by  the  exclus- 
ive examination  of  females.  They  should  know  that  the  exam- 
ination of  the  male  visitors  is  made  in  a  practically  thorough 
manner  by  the  women  themselves.  The  physical  configura- 
tion of  the  male  organs  makes  this  an  easy  task,  and,  fur- 
thermore, the  doctors  of  the  Clinic  give  to  those  few  who  are 
inexperienced  the  necessary  information.  A  daily  consulta- 
tion hour  for  the  free  examination  and  treatment  of  men  for 
venereal  diseases  had  moreover  been  determined  upon  by  the 
Advisory  Committee. 

At  our  institution  these  women  are  accorded  the  treatment 
of  private  patients.  We  experience  no  difficulty  or  resistance 
in  the  carrying  out  of  our  system ;  we  issue  no  commitment 
to  a  lock  hospital ;  the  hospital  in  which  our  patients  are  taken 
care  of  is  unlocked,  free,  with  only  one  escape  registered  dur- 
ing the  two  years  of  our  work.  Thus  we  try  to  reconcile  the 
necessity  of  enforcing  sanitary  control  of  this  distressing 
malady  with  the  modern  spirit  of  forbearance. 

Although  during  the  two  years  of  our  \vork  the  morbidity 
among  our  clients  has  been  decreased  from  147  to  an  average 
of  about  50  per  thousand  and  although  of  those  continually 
under  our  supervision  (old  registration)  only  4.5  per  cent  are 
infected,  while  among  the  fresh  entries  (new  registration), 
38.6  per  cent,  or  more  than  eight  times  as  many  are  afiflicted, 
still  we  realize  that  our  work  is  far  from  accomplishing  per- 
fect results.     Here  are  the  exact  figures  for  this  year : 

COMPARATIVE    LABORATORY    REPORT    OF    INFECTED    CASES 
OLD    REGISTRATIONS 
Month  Number  Number 

Reporting  Found 

Diseased 
1911,  Mar.    (1st   month   of   clinic's 

operations) 
1913,  Jan.  685  30 

Feb.  665  31 

Mar.  678  34 

Apr.  650  31 

May  664  31 

POLICE   SUPPORT   OF  THE   CLINIC  WAS  W^ITHDRAWN   MAY   20.    1913 

Nothing  in  our  work  should  hinder  the  immediate  intro- 
duction and  energetic  pursuit  of  other  medical  as  well  as  edu- 
cational measures  to  lessen  the  ills  and  to  guard  against  the 
temptations  of  prostitution.  It  would  greatly  aid  the  sanitary 
work   if   an    immediate   report   by   physicians   of   every  client 

27 


NEW 

REGISTRATIONS 

r   Cent 

Number 
Registered 

Number 
Found 

Pe 

r   Cent 

Diseased 

14.69 

14.69 

4.3 

70 

16 

22.8 

4.8 

31 

12 

38,7 

5.0 

29 

4 

13.8 

4.77 

26 

6 

23.08 

4.66 

29 

3      . 

10.35 

sutTorin_ii'  from  \oiiorcal  diseases  would  be  sent  lo  the  local 
hcallh  authorities  and  suhse(|ueiU  official  watchfulness  exercised 
o\er  these  jxitients. 

It  is  very  doubtful,  however,  if  laws  to  compel  full  reports 
and  control  would  be  obeyed  in  the  face  of  the  social  disi;race 
which,  at  present,  these  venereal  diseases,  when  disclosed, 
entail  upon  their  unfortunate  victims.  The  California  State 
r.oard  oi  liealth  has  issued  a  regulation  for  all  physicians 
within  this  state  to  report  such  cases  of  venereal  infections, 
by  a  private  current  number  only,  to  the  secretary  of  the  board. 
Although  secrecy  is  fully  guarded  by  this  measure,  as  the 
board  never  learns  the  names  (,)f  the  patients  reported  to  them 
by  number,  nor  identifies  them  in  any  other  way.  still  the  re- 
turns during  the  three  years'  life  of  this  regulation  have  been 
quasi  nil. 

It  will  take  many  years  to  reconcile  the  American  public  to 
such  a  step  which  uncovers  the  most  intimate  private  actions. 
While  it  must  be  granted  that  a  general  law  requiring  full 
report  and  strict  control  of  all  venereal  diseases,  if  eventually 
carried  out,  is  bound  to  aid  in  the  preservation  of  the  nation's 
health,  it  will  not  replace  the  Clinic's  work  which  is  based  upon 
immediate  action  against  the  scourge  of  today. 

The  plan  to  have  sex  hygiene  taught  in  the  higher  grades 
of  the  public  schools  is  most  commendatory,  according  to  our 
judgment. 

This  work  has  for  some  time  been  carried  on  in  various 
European  countries  and  an  extensive  illustration  of  its 
methods,  with  all  the  paraphernalia  requisite  for  a  thorough 
although  delicate  and  painstaking  instruction,  w^as  ex- 
hibited in  that  wonderful  Dresden  Hygiene  Exposition  of  1911, 
and  on  a  smaller  scale  in  the  Congress  of  Hygiene  and  Demo- 
graphy at  \\'ashington,  D.  C.  in  1912. 

This  instruction  has,  in  a  measure,  been  introduced  in  the 
schools  of  Chicago  and,  according  to  a  most  reliable  and  lucid 
report  of  Prof.  C.  E.  Rugh,  has  met  with  complete  success. 
Its  general  introduction  throughout  the  country,  however, 
will  have  to  fight  a  very  powerful  opposition  which  will  retard 
its  adoption  for  an  indefinitely  long  period. 

One  of  the  inestimable  advantages  of  the  Clinic's  work  is 
that  it  need  not  rely  upon  vague  promises  of  a  possible  future 
help,  but  it  benefits  the  people  of  today  and  tomorrow.  Its 
good  results,  however,  were  not  solely  confined  to  the  field  of 
sanitation. 

To  our  successful  work  was  also  due  the  practical  dis- 
appearance of  the  procession  of  street  walkers,  so  that  solicit- 
ing on  public  thoroughfares  rarely  occurred  in  this  city.     In 

28 


the  reduction  of  the  morbidity  to  about  one-third  among  our 
entire  floating  contingent  of  approximately  2,500  women  and 
of  nearly  1,000  individuals  during  each  month,  we  prevented 
at  a  conservative  estimate,  the  possibility  of  infection  in  far 
over  100,000  cases  annually  in  this  city  alone.  This  is  a  task 
well  worth  every  possible  effort,  and  if  our  application  for 
separate  examination  of  the  public  dance  hall  girls  had  be- 
come an  order,  these  girls  having  been  freed  from  control, 
although  they  are  nearly  exclusively  recruited  from  houses  of 
prostitution  and  constantly  interchange  with  the  inmates,  we 
should  have  increased  considerably  the  number  of  prevented 
infections. 

The  constant  friendly  commvmication  between  staff,  em- 
ployees and  clients  has  been  conducive  toward  establishing 
a  confidential  relationship,  and,  without  any  direct  missionary 
effort  or  intention,  it  has  been  possible  to  rehabilitate  a  large 
number   of  these   unfortunates. 

ABOUT  140  WOMEN  HAVE  BEEN  PROVIDED 
WITH  AN  OPPORTUNITY  OF  QUITTING  THIS  LIFE 
BY  SECURING  THEM  RESPECTABLE  POSITIONS. 

OVER  50  NEOPHYTES,  UPON  MAKING  APPLICA- 
TION FOR  REGISTRATION,  WERE  PERSUADED  TO 
REFRAIN   FROM   ENTERING  THE   LIFE. 

A  NUMBER  OF  MINORS  WERE  TURNED  OVER  TO 
THE  JUVENILE  COURT. 

A  RELATIVELY  LARGE  NUMBER  OF  WHITE 
SLAVERS  WERE  TRIED  AND  CONVICTED  IN  THE 
LOCAL  AND  FEDERAL  COURTS  MAINLY  THROUGH 
OUR  AGENCY  AND  EFFORTS. 

The  labors  of  all  the  local  social  and  religious  societies 
for  moral  uplift  in  this  special  field  have  been  incomparably 
far  outdone  by  the  results  of  this  part  of  the  Clinic's  work. 

Although  not  loudly  programmed  as  lying  within  the  scope 
of  our  chiefly  sanitary  efforts,  this  growth  of  kindly  relations 
between  the  sympathetic  physicians  as  well  as  nurses,  and 
their  clients,  offers  by  far  the  best  opportunities  to  ask  for 
and  take  the  ever-ready,  helping  hand  of  the  Clinic's  staff. 

The  Clinic  has  received  many  inquiries  from  all  over  the 
United  States,  especially  since  the  preliminary  publication  in 
the  New  York  Medical  Record,  March  13,  1913.  of  my  paper 
on  the  Municipal  Clinic  of  San  Francisco  read  before  the  Inter- 
national Congress  of  Hygiene  and  Demography  in  Washington, 
D.  C,  September,  1912.  The  Boards  of  Health  of  many  places, 
including  that  of  the  great  City  of  New  York,  honored  us  by  re- 

29 


qiicsliiij;  the  ik'tails  o\  our  system,  a  comploto  set  of  our  cards 
and  fonns.  tor  stutly  aud  imitative  adoptiou.  I-'ven  to  the  I'liited 
States  Ciovermnent  otVicials  in  l^orto  Rico,  this  system  appealed 
and  they  recpiested  complete  and  detailed  information. 

'I'he  interest  in  our  successful  experiment  has  extemled 
farther  from  mere  i)rofessional  and  official  circles  into  the 
ranks  of  civic  clubs  and  societies.  Let  me  (|uote,  as  one  of 
many  instances,  letters  from  the  Woman's  Municipal  League 
c^f  Xew  York  C'itv.  as  follows: 


WOM.WS    MrXUIl'AI.    Li;.\GrF.    OF 
•46    EAST   29TII    STRKET 


Miss 
Mrs. 
Mrs. 
Mrs. 
Mrs. 
Mrs. 
Mrs. 
Mrs. 
Mrs. 
Mrs. 
Mrs. 
Mrs. 
Mrs. 
Mrs. 


Directors 
Sadie   American 
Walter  S.    Brewster 
Camden   C.   Dike 
Harvey   E.    Eiske 
Wm.    M.    Jackson 
Edward    E.    I.oomis 
George    .\.    Lung 
Gilbert    Montague 
Redford   J.    Mount 
George    D.    Pratt 
Henry    Seligman 
Brandreth    Symonds 
John   C.   Tappin 
Gordon    Wendell 


THE    CITY   OF    NEW    YORK. 
Tel.    Madison    Square    4190 


President 
Mrs.    Edward     R.     Hewitt 
Vice-President 
Mrs.    Barclay   Hazard 

Second   Vice-President 
Mrs.   Thomas  B.   French 

Third    Vice-President 
Mrs.   H.    Clinton    Backus 

Corresponding  Secretary 
Mrs.    Annette    .Summer    Ross 
Recording    Secretary 
Mrs.    John    Hiiddleston 
Treasurer 
Mrs.   Frederick  C.  Hodgdon 


Dr.  Julius  Rosenstirn. 
Municipal    Clinic, 

San   Francisco,   California. 
Dear  Sir; — 

It  is  some  time  since  vvc  have  had  any  exchange  of  correspond- 
ence, but  our   interest   in   your   work   continues   unabated. 

As  you  are  aware,  we  are  trying  in  New  York  to  bring  ourselves 
to  some  systematic  way  of  dealing:  with  the  great  question  of  pros- 
titution. So  far,  there  are  nearly  as  many  theories  advanced  as  tliere 
are  social  science  students  to  advance  them,  but  we  still  think  (those 
of  us  who  are  not  run  away  with  their  own  ideas),  that  it  is  possible 
to  learn  by  the  experience  of  other  people  and  other  communities. 

W'ith  this  end  in  view,  I  am  writing  to  ask  if  you  would  be  will- 
ing to  receive  as  a  volunteer  worker  in  your  Clinic,  Miss  Marjorie 
Clark  of  this  city.  Miss  Clark  is  a  trained  nurse  and  had  charge  for 
three  years  of  the  free  dental  clinic  established  by  Judge  Peter  T. 
Barlow.  We  wish  to  emphasize  the  fact  that  should  you  be  willing 
to  give  Miss  Clark  the  benefit  of  this  opportunity  to  observe  the 
workings  of  your  Clinic,  that  the  investigation  would  be  conducted 
in  a  most  sympathetic  spirit.  This  is  not  to  say  that  we  commit 
ourselves  to  either  segregation  or  to  a  Clinic  such  as  yours,  but  it 
does  mean  that  we  consider,  granted  these  conditions,  that  San  Fran- 
cisco and  your  Municipal  Clinic  are  meeting  the  question  logically 
and  scientifically,  and  that  no  better  laboratory  could  be  found  to 
study  this  terrible  question. 

Miss  Clark  will  enclose  a  letter  from  herself,  and  your  reply  may 
be  addressed  either  to  her  or  to  us  here. 


30 


In    closing,   may    I    request   you   to   send   me   any   other   material 
that  you  may  have  on  hand  that  may  be  useful  for  us  here. 

With   renewed   assurances   of  our  best   wishes   for   the   success   of 
your  experiment,   I   remain. 

Yours  very  truly, 
MRS.  BARCLAY  HAZARD.  ALIDA  B.  HAZARD, 

Vice-President. 


609  West  127th  St.,  New  York,  N.  Y. 

May   7th,    1913. 
Dr.    Julius    Rosenstirn, 
Municipal   Clinic, 

San    Francisco,    Cal. 
Dear   Dr.    Rosenstirn: 

Enclosed  please  find  Mrs.  B.  Hazard's  letter.  It  fully  explains 
my  ambition  to  study  your  Clinic  which  I  think  is  the  first  logical 
step  towards  the  solution  of  this  great  problem.  I  have  studied  your 
cards  and  administration  and  believe  it  to  be  the  best  system  in 
vogue.  I  shall  be  deeply  grateful  to  you  for  whatever  assistance  you 
may  be  able  to  give  me. 

Should  you  see  the  way  clear  to  grant  my  request,  I  would  like 
to  report  at  your  Clinic  in  September. 

Respectfullv  yours, 

(Signed)  MARJORIE    CLARK. 

In  the  face  of  this  general  appreciation  from  so  many  and 
so  widely  different  communities  and  institutions  throughout 
the  country,  what  has  been  the  support  and  encouragement 
given  to  this  pioneer  pathseeker  by  its  own  home  legislative 
and  governing  bodies  and  townsmen? 

From  the  legal  departments  we  received  the  following 
letters: 


DISTRICT  ATTORNEY.     HALL  OF  JUSTICE 

San  Francisco,  February  26th,  1913. 
Honorable  James  Rolph,  Jr., 

Mayor  of  City  and  County  of   San   Francisco, 
San   Francisco,   California. 
Dear   Sir: — 

I  have  been  informed  tliat  there  is  an  agitation  started  for  the 
purpose  of  abolishing  the  Municipal  Clinic.  I  am  strongly  of  the 
opinion  that  it  would  be  a  great  mistake  to  abolish  that  institution. 

The  Clinic  has  given  this  ofifice  valuable  assistance.  During  the 
past  year  we  have  tried  about  twenty-five  white  slave  cases.  In  the 
majority  of  these  cases  the  evidence  has  been  furnished  through  the 
assistance  of  the  officers  connected  with  the  Clinic.  In  fact,  the  prose- 
cution of  these  cases  could  not  have  been  successful  if  it  were  not 
for  the  help  of  that  office.  I  may  also  add  that  members  of  the 
U.   S.   Immigration   Office   have  been  given  like  assistance. 

An  army  physician  informed  me  that  venereal  diseases  among 
soldiers  had  declined  greatly  since  the  opening  of  the  Clinic.  Tlie 
closing  of  the   Clinic   cannot   nor   will   not    tend    to   check   prostitulioii, 

31 


.111(1   (111   tlu>   dtlicr   liaiul   it   it   is   ch^st'd   it    will  destroy   the   good   work 
already   accomplished    in    clieckin>i:   disease. 

Tlie  fact  that  the  white  slaver  and  the  t|uack  doctor  are  strongly 
opposed  to  its  existence  is  a  strong  argument  why  it  should  con- 
tinue  to  exist. 

I  am  contulent  that  the  Clinic  is  not  only  scicntilically.  hut  is 
honestly  C(Mulucted.  The  two  past  (jraiul  Juries,  after  a  thorough 
investigation,  not  only  commended  the  manner  in  which  it  was  con- 
iluctcd,  but  also  recommended  its  continuance. 

I  believe  members  of  the  medical  profession  arc  better  able  to 
judge  of  the  necessity  for  its  existence  than  any  other  class  of  people, 
and  I  feel  confident  that  most  all  members  of  the  medical  profession 
will  admit  that  such  an  institution  is  necessary  in  a  city  of  this  size. 

Very   truly  yours, 

(Signed)  C.   M.   FICKERT, 

District  Attorney. 

Department  of  Justice 
OFFICE  OF  UNITED  STATES  ATTORNEY 

Terms  of  Court.  For  the  Northern  District  of  California.  U.  S.  Circuit  of 
Appeals — At  San  Francisco,  first  Mondays  in  October,  February  and  May.  U.  S. 
District  Court — At  San  Francisco,  first  Monday  in  March ;  second  Monday  in 
July :  first  Monday  in  Xovember.  At  Sacramento,  first  Monday  in  April.  At 
Eureka,    Third    Monday    in   July. 

San   Francisco,   February   18,   1913. 
Dr.  Julius  Rosenstirn, 

126   Stockton    Street, 
San  Francisco. 
My  Dear  Doctor: — 

I  am  in  receipt  of  your  request  that  I  write  you  briefly  the  ex- 
perience which  the  United  States  Attorney's  oflfice  has  had  with  the 
Municipal  Clinic  of  San  Francisco. 

Practically  the  only  opportunity  which  I  have  had  for  the  ob- 
servation of  the  work  of  the  Clinic  has  arisen  in  the  trial  of  the 
white  slave  cases.  Possibly  you  may  be  aware  of  the  extreme  diffi- 
culty which  the  prosecution  has  always  experienced  in  securing  the 
testimonj'^  of  the  keepers  of  questionable  resorts.  This  difficulty  has 
confronted  us  in  the  presentation  of  cases,  but  has  been  practically 
removed  through  the  prompt  and  efficient  assistance  given  to  us 
by  the  officials  of  the  Municipal  Clinic.  In  every  case  where  we  have 
been  confronted  with  the  difficulty  of  securing  testimony  of  this 
character  when  we  knew  that  in  truth  it  could  be  produced,  all  we 
have  had  to  do  is  to  request  the  Municipal  Clinic  to  order  the  women 
in  question  to  call  at  this  office  and  state  the  truth  and  then  go  on 
the  stand  and  testify  fully  and  freely.  This,  the  women  have  done 
in  every  case  where  we  have  called  upon  the  Clinic  for  assistance. 
The  result  has  been  conviction  after  conviction,  where,  without  the 
assistance  of  the  Clinic,  I  think  we  would  have  been  helpless. 

I  have  not  hesitated  to  express  my  opinion  repeatedly  that  the 
experience  of  this  office  with  the  Clinic  has  left  a  most  favorable  im- 
pression on  our  part.  In  prosecutions  it  is  the  result,  and  not  the 
sentiment  that  counts,  and  any  organization  which  enables  the  gov- 
ernment to  secure  convictions  of  guilty  persons,  is  entitled  to  have 
that  fact  stated  to  its  credit. 

Respectfully, 

(Signed)  J.    McNAB, 

United    States    Attorney. 

32 


The  report  of  the  last  Grand  Jury  speaking  of  the 
Municipal  Clinic,  states: 

"The  so-called  social  evil,  which  has  been  a  source  of  much 
serious  reflection  and  consideration,  is  now  being  handled  by  the 
Municipal  Clinic,  a  sub-body  composed  of  professional  and  business' 
men,  and  is-  doing  splendid  work,  and  the  attention  of  all  large  cities 
in  this  and  foreign  countries  has  been  called  to  it.  This  work  should 
be  assisted  in  every  possible  way  and  made  lawful  by  an  act  of  the 
Board  of  Supervisors.  A  Vice-Commission  might  be  the  best  way 
to  control  this  class,  and  with  the  backing  of  the  Police  Courts  and 
Police  Department  the  splendid  results  so  far  attained  would  be 
added  to  and  this  particular  work  be  a  precedent  to  the  whole  world. 

"We  recommend  that  women  who  are  employed  in  dance  halls 
in  this  city  should  be  under  the  control  of  the  Municipal  Clinic,  in 
order  that  they  may  report  thereto  for  examination.  This  recom- 
mendation is  made  in  view  of  the  fact  that  women  of  the  under- 
world, when  diseased  and  unable  to  meet  the  rigid  examination  of  the 
Clinic,  usually  resort  to  dance  halls  in  the  Tenderloin  district  above 
referred  to  and  to  the  dance  halls  on  Pacific  street  and  thereabouts. 
This  method  should  either  be  regulated  by  an  ordinance  to  be  passed 
by  the  Board  of  Supervisors  or  a  rule  of  the  Police  Department. 

The  present  Grand  Jury  has  not  yet  submitted  its  report, 
but  its  foreman  Mr.  Dumbrell,  in  a  letter  addressed  to  his 
Honor,  the  Mayor,  says : 

"Particularly  do  I  desire  to  commend  the  maintenance  of  what 
is  known  as  the  Municipal  Clinic  and  the  so-called  "Segregation  Dis- 
trict.' Nothing  could  more  conduce  to  civic  morality,  nothing  could 
better  militate  against  the  spread  of  the  'world  old  evil'  than  this 
separation  of  the  evil  and  the  immoral  from  the  clean  and  good." 

At  about  this  time  the  universal  immediate  purity  move- 
ment, wildly  rampant  in  the  Middle  West,  this  movie  show 
of  the  vanguard  of  self-righteous  civilization,  struck  our  city. 
Here,  as  everywhere,  excellent  men,  leaders  and  members  of 
church    organizations,    men    with    the    best    intentions    but 
strangely  ignoring  the  ways  of  the  world,  refusing  any  conces- 
i   sion   to   natural   human   instincts   and   passions,   were   the   in- 
j  stigators  of  this  movement.     It  was  primarily  aroused  through 
1  the  most  justified  horror  and  indignation  from  the  Vice  Com- 
mission's  exposure   of   the   terrible   White   Slave   traffic,   and 
led   to   a   relentless   warfare   against   this   miserable   pest,   the 
White   vSlaver.     But,   not   satisfied   with   that,   the   movement 
culminated  in  a  fiery  crusade  against  the  victims  of  the  social 
malady  and  the  more  or  less  tempting  places  of  amusement — 
dance  halls,  restaurants  and  cafes  with  dancing  licenses. 

The  leaders  of  this  movement  disregarded  the  outcome  of 
hundreds  and  hundreds  of  years  of  the  most  cruel  ill-treatment 
and  punishment  of  prostitutes.  They  disregarded  the  fact 
that  the  Church  had  for  the  same  purpose  of  su])pression  put 

33 


into  ;iotii»n  its  i;rcat  ijowor  of  luatorial  and  spiritual  persecu- 
tion ami  anatlicuias.  lUil  prostitution  has  siu-vived,  is  ilauntinij^ 
its  soilcil  banner  in  Sjiite  of  all  persecution  and  anathemas, 
and  even  the  thurch  has  spent  its  jiower  in  vain. 

A  new  era  has  dawned — a  modern  science  called  Social 
Hygiene  has  turned  its  searchlight  upon  the  domain  of  public 
life  in  its  sanitary  as  well  as  social  phases.  It  has  taken  a 
firm  hold  of  the  jiroblems  of  prostitution  with  its  injuries  to 
sanitary  and  social  well  being,  lu^t  iov  the  purpose  of  persecu- 
tion but  for  devising  possible  he\p. 

While  some  of  the  ministers  here  realized  that  this  work 
rightly  belonged  to  scientific  experts,  others  were  less  will- 
ing^ to  take  this  view.  A  cry  was  started  against  the 
Municipal  Clinic.  A  meeting  was  called,  predominantly  un- 
der the  .sway  of  the  unwilling  gentlemen.  One  of  these  ex- 
cellent divines,  a  man  of  rare  intelligence  and  strength,  be- 
came violently  condemnatory  in  his  denunciation  of  the  morals 
of  this  city.  Later  on,  in  the  course  of  his  address  he  grew^ 
strongly  abusive  of  the  Municipal  Clinic,  an  institution  he  had 
never  been  curious  enough  to  visit  or  inspect.  The  zeal  for 
his  reformatory  views  carried  him  so  far  as  to  threaten  the 
men  in  charge  of  the  World's  Fair,  with  exposing  local  con- 
ditions as  he  saw  them  on  his  proposed  Eastern  lecture  tour, 
which  expose  would  prevent  religious  associations  from  hold- 
ing' their  conventions  here  in  the  Exposition  year,  1915.  and 
would  rob  San  TVancisco  of  the  well  known  lavish  expend- 
itures of  this  class  of  good  citizens. 

These  accusations  and  threats  roused  energetic  protests 
from  several  other  representative  clergymen.  One  of  them,  a  gen- 
tleman of  the  highest  standing,  felt  it  his  duty  to  denounce 
him  as  a  traitor,  and  he  with  others  refused  to  join  in  the 
attack  on  the  Clinic.  Nevertheless,  a  set  of  resolutions  was 
passed  by  the  assemblage,  appointing  a  committee  to  go  be- 
fore the  flavor  and  demand,  among  other  things,  the  abolition 
of  the  Clinic. 

The  stenographic  report  of  these  deliberations  furnishes 
most  remarkable  evidence.  There  were  men  whose  lifework 
revolved  around  the  task  of  inculcating  the  human  mind  with 
the  great  geocentric  error  of  raising  this  insignificant  little 
planet  of  ours  to  the  center  of  importance  among  the  millions 
and  millions  of  other  astral  bodies  filling  the  universe.  These 
same  men,  by  a  curious  transportation  of  letters,  changed  the 
geocentric  into  the  egocentric  error,  placing  themselves  in  the 
center  as  models  for  the  rest  of  humanity  to  emulate  what  they 
preach,  if  not  always  practice. 

34 


As  a  result  of  this  agitation  Supervisor  ]\Iur(lock  attacked 
the  CHnic  at  a  meeting;  of  the  Board  of  Supervisors  on  February 
13,  1013,  and  introduced  a  resolution  to  forbid  the  use  of  the 
word  "Municipal"  in  connection  with  the  name  of  the  Municipal 
Clinic,  also  to  censure  its  existence  and  purpose,  and  to  withdraw 
official  recognizance  or  aid. 

This  resolution  was  shown  to  his  Honor,  the  Mayor,  pre- 
vious to  the  meeting  of  the  Board.  The  Mayor  assured  me 
privately  that  he  had  asked  Supervisor  Murdock,  as  a  personal 
favor,  not  to  present  it,  and  that  Mr.  Murdock  promised  to 
comply  with  the  request.  Later,  during  the  progress  of  the 
meeting,  this  gentleman  asked  the  Mayor  to  release  him  from 
his  promise  and  allow  him  to  introduce  it.  The  respect  for 
the  age  of  the  Supervisor,  and  the  evident  honesty  of  his 
purpose,  although  its  error  was  recognized,  carried  the  first 
part  of  the  resolution — the  disapproval  of  the  name ;  the 
rest  of  it  was  stricken  out  unanimously,  with  the  exception 
of  the  originator's  vote.  The  resolution  as  it  passed,  read  as 
follows : 

Joint  Resolution,  No.  604 

"Whereas,  the  use  of  the  word  'Municipal'  in  connection  with 
the  Clinic  conducted  by  individuals  at  682  Commercial  street  is  mis- 
leading, implying  that  the  agency  is  conducted  or  controlled  by  the 
City   Government,   therefore  be   it 

"Resolved;  that  the  use  by  any  organization  or  individuals  of  the 
name    'Municipal    Clinic'    is    hereby    forbidden." 

This  was  done  to  relieve  the  shock  the  title  gave  to  Mr. 
Murdock,  regardless  of  the  fact  that  this  name  was  not  chosen 
by  us,  but  given  to  our  institution  by  the  previous  Board  of 
Health,  which  called  the  Clinic  into  existence.  Another  fact 
remained  undiscussed,  that  not  fifty  yards  from  the  new  Hall 
of  Justice  a  saloon  is  being  conducted  under  the  name  of  "The 
Municipal  Bar,"  with  nobody  holding  the  honorable  Board 
responsible  for  the  quality  of  its  liquors. 

The  Advisory  Board  was  most  willing  to  comply  with  the 
Supervisorial  order  but  wished  for  the  new  name  to  be  un- 
objectionable to  all  parties,  as  change  of  stationery  and  print- 
ing entailed  a  not  inconsiderable  expense. 

I  first  called  upon  the  Police  Commissioners  and  was 
directed  by  them  to  seek  the  Mayor's  sponsorship  for  the  new 
baptism.  Some  little  time  elapsed  before  an  api)ointment 
could  be  made  and  then  I  was  told  by  his  Honor,  the  Mayor, 
to  seek  the  advice  of  Mr.  Roche,  the  newly  ap])()jnte(l  ])resi- 
dent  of  the  police  commission,  with  the  promise  that  anythinpj 
which  pleased  him  would  also  suit  the  Mayor.     After  several 

35 


unsuccessful  attcmins.  Mr.  KdcIic  was  caupjht  on  the  telephone 
and  preferreil.  as  1  understood  him,  not  to  make  any  detinite 
l>roposition  at  that  time,  hut  recommended  that  we  wait  until 
the  entire  contrmersy  had  heen  settled. 

The  aijitation  did  not  stop  there.  A  meeting  was  called 
for  I-'ehruary  20.  VH3,  for  the  committee  of  the  hostile  anti- 
clinicians,  composed  of  Rev.  Dr.  Leavitt,  and  Messrs.  Wein- 
stock  and  ITerrin,q:ton.  They  were  to  meet  the  Police  Com- 
missioners and  the  Advisory  Committee  before  the  Mayor 
and  the  I'oard  of  Supervisors.  The  opposition  to  the  Clinic 
was  voiced  by  the  three  named  e^entlcmen  of  the  anti-clinicians. 
The  Clinic  was  represented  by  ^Messrs.  Metson  and  Ford  and 
the  writer  from  the  Advisory  Committee.  I  am  glad  to  say 
the  Police  Commissioners.  Messrs.  Roche.  Kuhl  and  Cook, 
also  spoke  very  strongly  and  favorably  for  the  Clinic. 

At  the  close  of  the  very  prolonged  session  the  Mayor 
stated  in  a  short  speech  that  he  had  attentively  listened  to  the 
arguments,  would  carefully  examine  all  the  submitted  proofs 
and  documents,  and  later  announce  his  decision  accordingly. 
His  decision  came  out  in  a  personal  interview  published  in 
"Town  Talk."  March  8.  1913.  where  he  answered  to  the  question: 

"How    about    the    Municipal    Clinic?" 

Mayor  Rolph — "I  think  it's  one  of  the  best  institutions  \vc  have. 
It  does  a  great  work  of  charity,  as  well  as  of  cleanliness.  After 
hearing  the  arguments  pro  and  con  I  am  more  in  favor  of  it  than 
ever." 

This  suspended  state  of  affairs  continued  until  May  20, 
1913,  when  to  my  great  surprise,  the  Clinic  was  suddenly  in- 
formed that  police  protection  had  been  withdrawn.  I  voiced 
my  astonishment  and  asked  the  Police  Commissioners  for 
the  reasons.  They  assured  me  privately,  and  also  openly  ex- 
pressed in  the  daily  papers,  their  appreciation  of  the  Clinic's 
work,  their  desire  that  it  should  be  continued  uncurtailcd,  and 
their  great  regret  that  political  influence  forced  them  to  de- 
cline the  continuance  of  police  protection. 

What  could  this  political  influence  be?  Whence  did  it 
emanate?  The  Police  Commissioners  are  appointed  by  the 
Mayor,  responsible  to  him  only.  He  had  expressed  himself 
strongly  and  unmistakably  in  favor  of  the  Clinic.  Could 
this  emasculated  resolution  of  the  Supervisors  have  influenced 
the  Mayor  and  Commissioners  so  far  as  to  change  their  at- 
titude toward  the  Clinic  in  spite  of  their  personal  convictions? 

•  I  interviewed  the  eighteen  members  of  the  P)Oard  of 
Supervisors,  who  with  one  or  two  exceptions,  all  assured  me 
of  their  friendliness  toward  the   ^lunicipal   Clinic.     In  order 

36 


to  wipe  out  any  false  impression  possibly  created  by  that 
memorable  Murdock  resolution  of  February  3,  1913,  the  fol- 
lowing new  resolution  was  presented  by  Supervisor  Paul  Ban- 
croft,  and   carried : 

Joint   Resolution.    Xo.   790 

Whereas,  the  Board  of  Supervisors,  on  February  3,  1913,  adopted 
Joint  Resolution,  No.  604,  as  follows: 

"Whereas,  the  use  of  the  word  'Municipal'  in  connection  with  the 
Clinic  conducted  by  individuals  at  682  Commercial  street  is  mislead- 
ing, implying  that  the  agency  is  conducted  by  or  controlled  by  the 
City   Government;   therefore   be   it 

"Resolved,  that  the  use  by  any  organization  or  individuals  of 
the  name  'Municipal  Clinic'  is  hereby  forbidden";  and 

"Whereas,  in  consequence  of  the  adoption  by  the  Board  of  Super- 
visors of  the  above  resolution,  the  impression  has  erroneously  gone 
forth  that  said  Board  of  Supervisors  disapproves  of  the  institution 
commonly  known   as   the   'Municipal    Clinic"   and 

"Whereas,  on  the  contrary,  said  Board  of  Supervisors  does  ap- 
prove of  the  manner  in  which  said  institution  has  been  conducted  and 
considers  that  the  work  performed  by  Dr.  Julius  Rosenstirn  and  the 
Advisory  Board  has  resulted  in  a  benefit  to  the  health  of  the  com- 
munity;  therefore  be  it 

"Resolved,  that  the  Board  of  Supervisors  hereby  endorses  the 
manner  in  which  the  so-called  'Municipal  Clinic'  has  been  conducted 
in   the   past;   and   be   it 

"Further  resolved,  that  in  order  to  better  safeguard  the  health 
of  this  community  the  Board  of  Supervisors  hereby  expresses  itself 
as  favoring  the  continuation  of  the  assistance  that  has  been  rendered 
until  recently  to  said  institution  by  the  Police  Department. 

It  was  adopted  June  9th,  1913,  with  the  following-  vote : 

Ayes,  15 — Supervisors  Bancroft,  Andrew  J.  Gallagher,  Giannini, 
Hayden,  Hilmer,  Hocks,  Jennings,  Koshland,  McCarthy,  McLeran, 
Murphy,    Nolan,    Payot,   Vogelsang — 15. 

Noes,  3 — Supervisors  Caglieri,  Mauzy,  Murdock — 3. 

I  thought  it  was  easy  sailing  now;  but  upon  my  urging, 
and  that  of  other  members  of  the  Advisory  Committee,  the 
Police  Commissioners  again  refused  restitution  of  the  police 
detail,  admitting  at  last  that  it  was  his  Honor,  the  Mayor, 
James  Rolph  Jr..  who  was  the  real  wielder  of  the  Big  Stick. 

I  then  sought  and  obtained  an  interview  with  the  Mayor. 
With  me  were  Supervisors  Bancroft,  Payot,  Andrew  Gal- 
lagher, and  Hilmer.  The  last  named  two  gentlemen  had 
visited  the  Clinic  during  morning  treatment  hours,  and  had 
incidentally  seen  an  apparently  perfectly  healthy  looking 
woman,  who  showed  on  her  soft  palate  a  perforated  syphilitic 
ulcer  of  about  the  size  of  a  quarter  of  a  dollar.  This  woman, 
during  the  weeks  of  treatment  at  the  Clinic,  since  the  cessa- 
tion of  police  supervision,  had  been  continuing  her  sad  trade 

■61 

9574?^ 


in  the  low  ili\o  she  occupied,  and  consiitutiiii;  a  source  of  in- 
fection lor  e\ery  one  of  her  fifteen  or  twenty  daily  \isitors. 
With  this  horrify inj;-  example  of  the  many  simihir  incidents 
fresh  in  their  memories,  the  Sni)ervisors  forcibly  presented 
their  impressions  to  the  Mayor.  lUit  neither  the  outspoken 
desire  of  the  lioard's  request  for  the  restoration  of  police 
surveillance,  nor  the  clear  reasoning;"  of  the  interviewinj;'  Super- 
visors could  induce  the  Mayor  to  alter  his  strange  change  of 
view.  When  1  told  his  Jlonor  that  1  would  see  the  Police 
Commissioners  in  the  evening,  he  went  so  far  as  to  be  willing 
to  wager  that  everyone  of  its  members  would  agree  with  him. 

That  evening  Mr.  Ford  and  I  went  to  the  meeting  of  the 
Pc^iice  Commissioners  to  call  their  attention  to  the  injustice 
of  their  action.  While  they  were  each  expressing  their  high 
appreciation  of  the  valuable  work  performed  by  the  Clinic, 
and  their  regret  at  being  obliged  to  revoke  the  grant  of  police 
surveillance,  his  Honor,  the  Mayor,  appeared  upon  the  scene. 
The  discussion  changed  to  the  reasons  profifered  by  his  Honor, 
the  INIavor,  and  his  Commissioners,  for  the  refusal  of  the  re- 
quest. 

They  were  : 

(1)  The  discrimination  against  women,  only  requiring 
their  examination,  and  not  of  men  visitors.  It  constitutes  an 
interference  with  the  personal  liberty  of  the  individual  to  re- 
quire this  examination.  (This  was  not  pressed  seriously,  be- 
ing only  an  echo  of  the  reasoning  of  the  women  protestants.) 

(2)  The  law  of  the  State  prohibiting  the  existence  of 
Houses  of  Prostitution,  (not  prostitution  itself),  police  sur- 
veillance formed  an  act  of  recognition  of  their  existence. 

(3)  The  new  Red  Light  Abatement  laws  just  passed  by 
our  legislature,  and  shaped  after  the  notorious  Iowa  laws. 

(4)  The  private,  instead  of  municipal  control  of  the 
Clinic. 

Their  objections  were  met,  and  we  believe  are  convincingly 
disproved,  by  these  statements  of  facts : 

Discrimination   Against   Women.     Interference   with 
Personal    Liberty 

I.  The  examination  of  male  visitors  is  regularly  made 
by  the  women  themselves.  Owing  to  the  external  position 
of  the  male  sexual  organs  this  is  an  easily  performed  task,  the 
knowledge  and  understanding  of  which  is  learned  almost  at 
once.  The  doctors  of  the  Clinic  have  been  instructed  to  ask 
clients  if  they  understand  these  measures  for  their  self-pro- 

38 


tion,  and  advise  them.  The  little  printed  folders  of.  the  Clinic 
books  inform  their  owners  of  this  precautionary  measure. 

As  to  the  discrimination  against  women  see  Case  51,  N.  Y. 
St.  Rep.,  p.  339  and  127,  N.  Y.  Suppl.— N.  Y.  Supreme  Court 
484,  and  same  case  129  N.  Y.  Suppl.,  p.  646,  N.  Y.  Supreme 
Court,  Appellate  Division. 

It  was  decided  that  it  does  not  violate  the  constitutional 
rights  of  a  prostitute  to  be  remanded  or  arrested  for  the  pur- 
pose of  examination  for  being  infected  with  venereal  disease, 
nor  if  found  infected,  to  committal  to  a  hospital  or  work- 
house, nor  is  the  act  discriminating  against  women  as  it  relates 
to  all  public  prostitutes  and  there  are  no  public  male  pros- 
titutes. All  this  being  a  sanitary  measure  for  the  protection 
and  security  of  the  public  health. 

This  decision  was  reversed  by  the  Court  of  Appeals  of 
New  York  on  a  mere  technical  default  of  the  law  which  in  no 
way  afifects  its  constitutionality  and  will  be  easily  corrected. 

People  ex  rel.  Barone  vs.  Fox.  202,  N.  Y.  616 — 96  North  Eastern 
Reporter,  page  1126. 

People  ex  rel.  Barone  vs.  Fox.  Warden  of  the  Workhouse  (Court 
of  Appeals  of  New  York,  June  16,  1911). 

Appeal  by  permission  from  an  order  of  the  Appellate  Division  of 
the  Supreme  Court  in  the  First  Judicial  Department  (144  App.  Div. 
611,  129  N.  Y.  Suppl.  646)  entered  May  16,  1911,  which  reversed  an 
order  of  Special  Term  (69  Misc.  Rep.  400-127.  N.  Y.  Suppl.  484)  sus- 
taining a  writ  of  habeas  corpus  and  discharging  the  relator  from 
custody,  dismissed  the  proceeding  and  remanded  the  relator  to  cus- 
tody. The  proceeding  was  brought  to  determine  the  constitutionality 
of  section  79  of  chapter  659  of  the  laws  of  1910  providing  for  a  medical 
examination  of  prostitutes  and  their  commitment  to  a  public  hospital 
if  found  to  be  afflicted  v.-ith  any  venereal  disease. 

Bertha  Renibaugh,  for  appellant.  Charles  S.  Whitman,  District 
Attorney  (Robert  S.  Johnstone  of  counsel*  for  respondent). 

Per  curiam  Order  reversed  and  relator  discharged  on  dissenting 
opinion  of  Clarke  J.  Below. 

Cullen,  C.  J.,  and  Haight,  Werner,  Willard,  Bartlctt,  Chase,  and 
Collin,  J.  J.,  concur. 

Gray,  J.,  dissents  on  opinion  of  Ingraham,   P.  J.,  below. 

Clarke's  dissenting  opinion  states  (adopted  by  Court  of  .Appeals)^ 
(conclusion):  . 

If  the  magistrate  to  be  satisfied  from  the  confession  r,f  tlie  person 

(plead  guilty)  brought  before  him  or  by  competent  testimony 

he  must  convict  him. 

It  is  the  absence  of  the  reciuircment  of  competent  testimony  in 
the  case  at  bar  that  affects  the  statute. 

In  the  fundamental  defect,  namely,  that  the  term  of  imprisonment 
depends  upon  a  fact  found  out  of  court  _by  a  non-judicial  officer,  this 
legislation  is  similar  to  that  condemned  in: 

Matter  of  Kenny,  23  Misc.,  Rep.  9-49  N.  Y.  Suppl.  lO,'^  F  affirmed 
on  the  opinion  below  30  App.  Div.  624,  53  X.  Y.  Suppl.  1111.     Soo  also 

39 


People  ex^  rcl.  Abranis  vs.  I'^ox  FF  App.  Divis.  245-79  N.  Y.  Suppl. 
56:  where  the  hiw  under  eonsideration  in  said  cases  after  anienthiient 
to  meet  tlie  defects  pointed  i)ut  was  sustained,  h'or  the  proposition 
that  tile  fact  that  tlie  oliject  and  purposes  of  an  act  are  not  penal,  but 
protective,  does  not  take  said  act  without  the  constitnional  i)rovisi(Mi 
as  to  due  process  of  law,  see  People  ex  rel.  Ordway  vs.  St.  Saviour's 
Sanitarium  34  App.   Div.  363.  56  N.   V.   Suppl.  431. 

I'dr  these  reasons,  and  without  considerinj^  further  objections  to 
the  legislation,  properly  disposed  of  at  the  Special  Term,  I  think  the 
order  appealed  froiH  was  riglit  and   sliould  be  affirmed. 

Dowling,  J.,  concurs. 

l-'urtherniore,  to  overcome  even  the  la.st  .scruples,  the  Advisory 
Coniiiiittee  offered  to  set  apart  an  hour  daily  for  the  examination 
and  treatment  of  men  afflicted  with  venereal  diseases. 

Recognition  of  Prostitution  by  Police 

II.  It  seems  like  an  insult  to  the  intelligence  of  the  people 
to  ask  them  to  believe  that  the  police  had  been  ignorant  and 
intolerant  of  prostitution  until  those  two  police  officers  were 
detailed  to  the  Clinic,  and  that  by  the  removal  of  those  two 
officers  there  was  again  restored  to  the  ])olice  its  happy  state 
of  ignorance  as  to  the  existence  of  prostitutes,  of  venereal  dis- 
eases and  all  the  horrors  attendant  upon  prostitution. 

The  sole  connection  the  Clinic  had  with  these  proceedings 
was  that  it  received  the  official  typewritten  information  from 
the  police  authorities  that  such  and  such  a  woman  had  been 

granted  permission  to  occupy  the  house  No. ,  in 

street,   or   that   such   a   woman   had   been   permitted   to   enter 

house .     These  blanks  are  the  only  source  of  information 

of  such  actions  the  Clinic  possesses,  and  they  remain  on  our 
files  for  reference.  No  house  of  prostitution  could  ever  have 
been  opened  without  the  permission  of  the  police  authorities. 
No  girl  could  ever  have  become  an  inmate  of  such  a  house 
without  their  knowledge  and  consent;  no  brothel  could  ever 
continue  to  exercise  its  lure  without  the  watchful  approval  of 
the  police. 

The  Red  Light  Abatement  Law^s 

III.  ^Ve  all  know  that  special  laws  concerning  morals, 
upon  which  the  views  of  people  are  decidedly  at  variance,  can 
only  be  followed  and  carried  out  to  a  certain  extent.  Such 
following  the  spirit  rather  than  the  letter  of  the  law  is  apparently 
the  better  way,  and  has  been  since  long  before  the  birth  of  the 
Clinic. 

The  new^  Red  Light  Abatement  Laws  belong  to  this  class 
of  laws.  Even  if  they  should  ever  be  accepted  by  the  people 
of  this  state,  a  consummation  devoutly  to  be  not  wished,  they 

40 


cannot  be  snccessfully  enforced.  The  conditions  in  the  towns 
of  Iowa  furnish  the  latest  example,  and  the  results  of  ex- 
haustive historical  research  as  expressed  by  Havelock  Ellis 
and  quoted  in  the  foregoing  pages  illustrate  the  experience 
of  civilized  nations  the  world  over  with  similar  attempts  of 
prohibitory  laws  in  the  history  of  prostitution. 

There  was  no  reason  to  withdraw  police  surveillance  long 
before  the  time  arrived  for  the  legal  enactment  of  the  new 
law  in  California.  A  referendum  petition,  which  has  since 
been  filed,  was  then  circulating.  It  will  put  the  vote  for  or 
against  these  laws  before  the  people  in  November.  1914.  until 
which  date  their  enactment  is  suspended.  \\'hy  let  contamina- 
tion with  disease  go  on  unhindered  until  that  time? 

The  Private  Instead  of  Municipal  Control  of  the  Clinic 

IV.  The  Advisory  Board  made  repeated  offers  and  ap- 
peals to  the  municipal  authorities  to  take  over  the  fully 
equipped  quarters  and  laboratories  of  the  Clinic,  including 
the  cash  surplus  for  the  rescue  home.  These  have  been  per- 
manent standing  offers,  but  have  constantly  been  declined. 
Our  proposition  was  referred  to  the  Hospital  Committee  of 
the  Board  of  Health  with  power  to  act.  Two  of  the  three  (all 
medical)  members  voted  against  the  adoption  of  the  Clinic. 
One  of  them  voted  for  reasons  of  shocked  morality,  the  other, 
a  specialist  for  women's  diseases,  said  the  medical  profession 
would  be  injured  financially,  and  would  object  to  free  treat- 
ment and  relatively  free  examinations  of  these  women.  I  feel 
certain  that  this  gentleman  did  not  voice  the  true  sentiment 
of  the  medical  fraternity. 

Is  it  right  to  refuse  protection  to  a  voluntary  fire  com]:)any 
and  thus  hinder  it  from  doing  effective  work,  if  no  other  fire 
company  exists  and  the  local  government  refuses  to  estal)lish 
one? 

This  regulation  for  examinations  should  be  construed 
simply  as  a  police  measure  for  the  protection  of  the  public 
health.     (See  New  York  decision.) 

The  Clinic's  only  activity  has  been  the  execution  of  tiie 
well-founded  sanitary  requirements,  justly  and  most  neces- 
sarily added  to  the  other  general  police  regulations  for  the 
supervision  of  prostitution.  Supervision  and  obligation  to 
conform  to  these  regulations  were  exercised  by  the  police, 
who  merely  took  their  iiifoniiatioii.  not  their  iiistruetion.  from 
our  records. 

To  satisfy  the  hypersensitive,  special  jjolice  officers'  stars 
might  be  awarded  to  the  superintendent  and  doctors  of  the 

41 


(.'linic.  and  even  the  mcinbcrs  of  the  Advisory  Board  would 
iitil  object  to  a  similar  decoration. 

After  all,  there  is  a  great  deal  of  truth  in  this  remark  of  the 
presiilent  of  the  lioard  of  Health,  a  lawyer  of  high  standing 
and  reputation  :  "The  present  independent  and  private  char- 
acter of  the  Municipal  Clinic  should  be  preserved  so  that 
persistent  and  sometimes  irresistible  political  demands  for 
appointments  might  be  ignored." 

The  same  may  be  said  regarding  the  su])pression  of  red 
light  graft  through  the  Municipal  Clinic.  Reviewing  some 
of  the  past,  and  considering  the  possibilities  that  may  arise 
from  ever-changing  future,  municipal  administrations,  we  be- 
lieve the  freedom  from  this  most  sordid  kind  of  graft,  a  free- 
dom which  the  regulating  system  of  the  Municipal  Clinic  in- 
sured, cannot  be  too  highly  estimated. 

Alas,  our  arguments,  although  found  incontrovertible,  were 
unsuccessful  in  moving  the  Police  Commissioners,  reinforced 
by  his  Honor  the  Mayor,  to  alter  their  decree. 

I  regret  to  state  that  two  ministers  of  the  gospel  deemed  it 
their  duty  to  voice  in  the  public  press  their  great  satisfaction 
with  this  crippling  of  the  sanitary  service  of  the  Clinic.  If 
the  remarks  of  these  two  gentlemen  had  been  simply  confined 
to  expressions  of  their  gratification  over  the  injury  the  Clinic 
had  suffered.  I  would  not  have  thought  it  necessary  to  com- 
ment upon  them.  But  their  articles  contained  serious  accusa- 
tions against  the  character  of  the  Clinic's  work,  and,  charging 
the  members  of  the  Advisorv  Board  with  being  criminals 
through  their  connection  with  this  institution,  called  upon 
them  to  confess  their  sins  and  repent. 

It  was  impossible  to  pass  this  public  arraignment  un- 
noticed. I  felt  compelled  to  correct  the  false  impressions  that 
had  been  introduced  into  the  people's  minds  through  the 
public  utterances  of  these  distinguished  gentlemen  and  most 
reluctantly  I  asked  the  newspapers  which  had  brought  the 
original  accusations  to  insert  the  following  explanatory  an- 
swers : 

CFrom  San   Francisco   Examiner,   Sunday,  June   1,    1913) 

CLINIC   GUARDS   CITY'S   HEALTH,   SAYS   PHYSICIAN 
Rosenstirn  Replies  to  Aked,  and  Asserts  Vice  Was  Not  Sanctioned. 

Upholds  San  Francisco's  Morality. 

One  of  the  Nation's  Cleanest  Municipalities,  Declares  Medico.     Others 

Copying  Methods. 

To  the  Editor  of  "The  San  Francisco  Examiner":  The  trium- 
phant cock-a-doodle-doo  of  the  Rev.  Dr.  Aked,  which  found  its  exult- 
ant expression  in  your  Sunday  issue  did  not  reach  my  ears  until  this 

42 


morning,  owing  to  my  absence  from  the  city  yesterday.  In  his 
phihppic  against  the  institution  he  thunders  a  column  of  accusations 
which  demand  immediate  rectification  for  an  all  too  credulous  public. 
Every  statement  he  has  made  regarding  the  actions  of  the  Clinic  has 
been,  to  say  the  least,  erroneous  and  misleading. 

The  Municipal  Clinic  is  purely  a  sanitary  institution.  When  it 
took  up  its  work  it  dealt  with  existing  conditions.  No  sanction  of 
commercialized  vice,  no  license  for  its  practice  was  ever  issued  by  its 
authority. 

Police  in  Control 

If  an  honest  search  for  the  truth  would  be  Dr.  Aked's  aim,  he 
could  have  easily  ascertained  that  the  police  authorities  have  always, 
before  and  since  the  opening  of  the  Clinic,  had  the  exclusive  and 
absolutely  independent  regulation  of  these  matters  in  their  own  hands, 
as  it  naturally  should  be. 

The  Clinic  merely  prevented  those  women  who  were  tolerated  to 
ply  their  pitiable  trade  from  combining  with  it  the  spread  of  disease. 

It  was  merely  adding  this  sanitary  condition  to  the  other  existing 
rules  exacted  by  the  authorities.  The  protection  granted  by  these 
examinations  simply  provided  visible  means  of  defense  against  harass- 
ment by  petty  grafting  from  self-appointed  authoritative  persecutors. 

During  the  two  years'  life  of  the  Clinic,  the  highly  efficient  and 
scientific  control  has  reduced  the  rate  of  disease  among  these  un- 
fortunates 66  per  cent. 

The  Clinic  Not  Closed 

For  the  first  time  in  the  history  of  similar  sanitary  controls,  a 
humane,  honest  and  sympathetic  treatment  has  been  followed,  and 
the  absolute  confidence  of  these  unfortunates  gained,  so  that  incidental 
rescue  work  and  white  slaver  prosecution  could  be  handled  as  it  never 
has  been  done  before.  This  confidence  is  shown  bj^  the  continued 
voluntary  submission  to  the  examinations  of  the  Clinic  now  that  the 
police  protection  has  been  withdrawn;  and,  for  the  pacification  of  the 
Rev.  Dr.  Aked.  let  it  be  known  that  on  Saturday  last  we  had  129 
individual  examinations,  so  the  Clinic  has  not  been  closed,  nor  will  it 
be  closed  until  the  enforcement  of  the  red  li.ght  abatement  bill  in  this 
city. 

If  it  is  a  blot  on  the  fair  escutcheon  of  San  Francisco,  as  Dr. 
Aked  contends,  that  the  Clinic  has  successfully  controlled  the  sanitary 
status  of  these  women  and  has  helped  the  sick  freely,  then  Dr.  .\kcd 
has  shown  the  qualities  of  a  high-grade  polisher  in  wresting  from  the 
administration  of  this  city  the  withdrawal  of  police  protection  of  the 
Clinic.  The  withdrawal  was  granted,  as  stated  by  the  Police  Com- 
missioners openly  in  the  public  press,  unwillingly  and  against  their 
better  judgment. 

Conditions  in  England 

What  has  he  to  offer  instead?  The  reports  of  vice  commissions 
that  segregation  has  not  decreased  the  social  evil,  and  the  anticipated 
changes  from  the  red  light  abatement  law  of  absolute  suppression? 
Vice  commissions  and  their  reports  have  been  known  before.  As 
Dr  Aked  undoubtedly  knows,  the  British  Royal  Commission,  upon 
the  administration,  etc.,  of  the  Contagious  Disease  Act  .of  1871,  and 
the  Parliamentary  Committee  of  1882  for  the  same  purpose,  were  such 
vice  commissions,  and  although  their  majority  reported  in  favor  of 
existing    regulations,    the     minority     report     for     their     abolition    was 

43 


.uloptotl    by    Parliiinu'iit    to    satisfy    just    siuli    petitions    and    ciTorts    of 
purists  and  hystorical  woniou  as  have  intUK-nccd  tliis  administration. 

Wliat  lias  Ik  on  the  result?  Liverpool,  tlie  luime  place  of  our 
eminent  divine,  shows  about  the  worst  conditions  of  any  luiropean 
liarbor;  l.inidon,  justly  the  pride  of  the  jjreat  British  Kmpire,  displays 
on  its  thoroughfares  an  ever  moving  chain-ganj^  of  solicitinjj  street 
Avalkers.  this  greatest  pest  of  the  social  evil;  all  the  lar.ner  and  nie<Iium- 
sized   KniTJish  cities  are  overrun  with  its  votaries. 

Other  Cities  Favor  Plan 

Irom  civil  authorities  all  over  the  Union  the  Clinic  receives  re- 
quests to  send  in  its  cards  and  forms  for  study  and  adoption;  even 
from  the  Board  of  Health  of  the  great  city  of  New  York,  but  they  did 
not  know  that  the  Rev.  Dr.  Aked  does  not  approve  of  our  Clinic.  Our 
carefullj-  collected  records  contain  tlie  answers  from  the  police  author- 
ities of  nearly  ninety  American  cities  of  25,000  inhabitants  and  over, 
to  our  queries  about  conditions  regarding  the  social  evil  in  their 
communities  and  as  to  the  effect,  social  and  sanitary,  of  measures 
taken  toward  it. 

Tliese  chiefs  of  police  and  their  officers,  who  are  in  continual  con- 
tact with  the  underworld,  are  the  men  who  possess  the  only  reliable 
knowledge  of  these  matters. 

Says  Iowa  Law  Failed 

In  these  answers  w-e  received  information  from  Iowa,  the  state 
that  now  has  had  two  years'  experience  of  red  light  abatement  laws, 
the  laws  from  which  our  Middle  West  legislators  copied  the  recent 
California  Iaw^  These  answers  plainly  state  that  the  laws  there  have 
failed;  that  persecution  has  driven  the  women  from  the  tolerated 
houses  into  the  residential  districts,  scattered  them  all  over  town;  that 
any  sort  of  control  seems  impossible,  and  that  physicians  say  diseases 
have   since  increased  fifty  per  cent. 

At  the  close  of  his  article,  the  Rev.  Dr.  Aked  deemed  it  expedient 
to  insert  an  apology  for  his  stand  against  the  fair  name  of  San  Fran- 
cisco. He  denies  ever  having  spoken  of  denouncing  our  city's  morals 
in  the  East,  or  of  thereby  preventing  the  intended  visits  to  the  1915 
Exposition  of  large  religious  societies  with  their  well  known  predilec- 
tions of  lavish  local  expenditures  on  these  occasions. 

These  are  the  facts: 

In  the  Mayor's  stenographic  report  of  the  vice  prevention  meet- 
ing in  the  Pacific  Building,  published  in  the  city  papers.  Dr.  Aked  is 
quoted  as  having  asked  what  would  be  the  result,  if  he,  in  his  approach- 
ing visit  East  and  in  the  lectures  he  was  engaged  to  deliver  before  the 
most  fashionable  audiences,  should  mention  the  depravity  of  our 
morals,  an  item  that  would  be  published  in  all  the  capers  throughout 
the  country,  and  what  efTect  this  would  have  upon  the  Exposition. 
Whereupon  the  Rev.  Dr.  Clampett  denounced  him  as  a  traitor  against 
the  city  of  his  adoption.  This  statement  has  never  been  contradicted. 
If  it  is  true,  does  it  not  show  the  plainest  indirect  threat  that  could 
be  made? 

And  this  statement  of  our  low  moral  standard,  before  the  advent 
of  the  Rev.  Dr.  Aked  and  during  his  first  ineffectual  attempts  for  our 
purification,  as  compared  with  other  large  cities  in  the  United  States, 
is  made  again  and  again  by  him,  and  reiterated  in  last  Sunday's  jubila- 
tion. What  are  his  assertions  and  those  that  have  been  furnished  to 
the    Eastern    press,    perhaps    only    indirectly   by   him,    founded    upon? 

44 


Upon  comparisons  with  other  large  commnnities?  Against  him  rises 
the  authority  of  the  Federal  Department  of  Justice.  The  representa- 
tive leader  of  its  seven  years"  investigation  of  these  matters  through- 
out the  country  recently  stated  under  oath  before  the  New  York  Cur- 
ran  Committee  that  "San  Francisco  was  among  the  very  best  moral 
cities  in  the  United  States;  Chicago  and  New  York  occupying  the 
worst  places."  With  the  acceptance  of  this  official  statement,  how  can 
one  excuse  those  other  wild  assertions  rushed  into  publicity  bv  wire 
and  print? 

Yours  for  health, 
DR.   JULIUS   ROSEXSTIRN. 
Chairman   Advisory  Committee,   Municipal   Clinic. 


To  the  Editors,  Call  and  Chronicle,  Sirs:  In  your  issue  of  vester- 
da3^  I  noticed  the  report  of  a  sermon  by  the  Rev.  Dr.  G.  E.  Burlin- 
game,  entitled  "The  Crime  of  the  Clinic." 

In  the  violence  of  his  indignation  the  Reverend  gentleman  has 
permitted  sortie  serious  mixups   to  enter  his   arguments. 

The  Clinic  is  accused  of  a  crime  against  weak  womanhood;  of 
offending  against  state  laws  and  city  ordinances  that  forbid  the  main- 
tenance of  brothels  and  the  frequenting  of  houses  of  ill-fame,  and  on 
the  strength  of  these  accusations,  the  Advisory  Board  is  branded  as 
composed  of  criminals  who  are  called  upon  by  the  Reverend  Doctor  to 
confess  their  sins  and  repent.  Let  me  state  for  the  information  of  the 
Reverend  gentleman  that  the  Clinic  takes  no  part  in  permitting  the 
existence  of  brothels;  this  task  has  always  been  and  is  now  performed 
solely  and   absolutely  by  the  police   authorities. 

The  Clinic  hlls  an  exclusively  sanitary  office,  that  of  watching  over 
the  health  of  women  to  whom  the  police  grant  permission  to  follow 
prostitution. 

This  has  been  done  to  minimize  as  much  as  possible'within  the 
power  of  the  Clinic  the  terrible  consequences  of  the  unremedied 
spreading  of  loathsome  diseases  from  that  source. 

To  what  extent  this  contamination  of  the  people  is  going  on, 
the  Reverend  gentleman  may  learn  from  a  recent  "Oration  on  Medi- 
cine" delivered  before  the  annual  meeting  of  the  State  Medical  Society 
of  Illinois  by  Dr.  -^dolphus  Knopfif,  Professor  of  Medicine  in  the  N'ew 
York  Post  Graduate  Aledical  College,  and  Director  of  Clinics  in  the 
New  York  Department  of  Health.  He  asserts,  according  to  a  moderate 
estimate,  that  there  are  1,000,000  infected  persons  in  the  community 
of  the   City  of  New  York. 

If  it  is  a  crime  to  try  to  lessen  this  ever  swelling  tide  of  disease- 
breeding  infections,  if  it  is  a  crime  against  womaniiood  to  try  to 
protect  these  unfortunate  women  against  the  physical  dangers  of  their 
degradation  by  watching  over  them  and  ministering  to  their  ailments, 
then  the  members  of  the  Advisory  Board  of  the  Municipal  Clinic  are 
criminals. 

They  have  stood  for  the  community's  protection  as  far  as  possible 
under  the  existing  circumstances;  the-  have  done  their  work  well, 
and  they  are  so  hardened  that,  although  confessing,  they  refuse  to  re- 
pent. 

They  also  think  that  if  the  Reverend  gentleman  will  leave  the 
field  of  sanitation  to  those  who  arc  fitted  for  such  work  by  a  pre- 
liminary education  in  that  field,  he  might  do  better  to  look  for  subjects 
for    repentance    among    those    numerous    members    of    his    own    cloth 

45 


who  scaiulali/c  ami  sliock  tlio  i>iihlic  sense  of  decency  liy  tlieir  offenses 
avjainst    morals. 

DR.   JULIUS   ROSEXSTIRN, 
Chairman   Advisory   Committee,   Municipal    Clinic. 


This  part  of  the  controversy  fortunately  ceased  with  the 
inililication  of  these  necessary  rectifications,  which  contained 
perhaps  more  acrimony  than  was  concomitant  with  the  dignity 
of  the  cause  but  seemed  pardonable  in  the  light  of  severe  and 
grountlless  accusations. 

Without  the  police  surveillance,  without  the  police  of- 
ficers to  prevent  the  bookless  and  diseased  prostitutes  from 
Inlying  their  sorry  trade,  the  usefulness  of  the  Clinic  is  practically 
destroyed  and  the  flow  of  contamination  from  venereal  dis- 
eases takes  up  again  its  constant,  unhindered  course  into  the 
flower  of  the  city's  manhood  and  womanhood. 

If  the  reader,  at  the  close  of  these  pages,  will  review  with 
me  briefly  some  of  the  salient  points,  we  shall  arrive  at  this : 

As  a  result  of  the  Clinic's  efforts  we  not  only  reduced  the 
number  of  venereally  infected  women  among  our  clients  to 
one-third,  thereby  saving  an  incalculably  large  number  of  in- 
dividuals from  infection  with  loathsome  diseases,  but  also 
made  it  possible  for  many  of  these  unfortunates  to  re-enter  a 
life  of  decency,  and  prevented  a  great  many  neophytes  from 
adopting  the  career  of  shame.  We  w^ere  instrumental  in  send- 
ing quite  a  number  of  minors  to  educational  institutes ;  and  last, 
but  not  least,  succeeded  in  convicting  and  conveying  to  the  peni- 
tentiaries a  number  of  white  slavers — these  most  contemptible 
and  despicable  of  all  criminals. 

The  methods  of  protective  sanitation  pursued  at  the  Mu- 
nicipal Clinic  differ  widely  from  those  employed  in  the  prin- 
cipal European  countries.  AVe  have  received  complete  copies 
of  their  regulations  for  the  moral  and. sanitary  control  of  the 
social  malady.  They  show  conclusively  that  older  criminating 
measures  have  not  been  abandoned  but  are  still  rigorously  en- 
forced. 

In  a  long  communication  received  but  a  few  davs  ago 
through  the  Department  of  State  from  the  American  Consul- 
General  at  Dresden.  Germany,  the  ordinances  and  rules  for  the 
regulation  of  prostitution  in  that  citv  have  been  transmitted 
to  us.  They  examine  prostitutes  there  once  a  week  in  a 
similar  manner  to  ours.  The  report  of  the  Consul-General 
states  verbatim  :  "The  present  system  has  been  in  existence 
foi"  ten  years  and  has  proven  a  success,  so  that  the  condition 
of  the  health  of  the  prostitutes  can  be  stated  to  be  excellent." 

If.    however,    one    would    take    the    trouble    to    read    their 

46 


regulations   one   would  be  astonished  at   some  of  the  medieval 
restrictions  that  are  enforced  upon  the  life  of  these  women. 

The  more  humiliating  and  oppressive  these  rules  be- 
come in  the  effect  of  their  enforcement  upon  the  red  light 
dwellers,  the  less  willing  these  women  are  to  submit  to  regis- 
tration and  periodical  examination,  but  seek  refuge  in  the 
ranks  of  clandestine  prostitution,  the  most  active  by  far  in 
the  spread  of  venereal  disease. 

In  spite  of  their  onerous  medieval  regulations,  the  civic 
authorities  in  Dresden  have  succeeded  far  better  than  other 
cities  in  overcoming  this  resistance  of  the  red  light  contingent 
against  medical  examination.  This  is  undoubtedly  due  to  the 
manner  of  enforcing  or  ignoring  the  obnoxious  rules  in  the 
well  known,  good-natured,  easy-going  fashion  of  the  Saxons. 

Professor  Adolphus  Knopff,  of  the  New  York  Post  Gradu- 
ate Medical  College,  and  Director  of  Clinics  in  the  Xevv  York 
Department  of  Health,  in  the  above  cjuoted  Oration  on  Medi- 
cine, delivered  before  the  Illinois  State  Medical  Society,  says 
regarding  this  system  of  sanitary  regulation  : 

"This  brings  us  to  the  most  difficult  of  all  the  problems 
created  by  the  social  ill.  Shall  a  community,  such,  for  example, 
as  New  York,  which  has  according  to  a  conservative  estimate, 
200.000  syphilitic  subjects  and  perhaps  four  times  as  many 
gonorrhoics,  and  40,000  to  50.000  ])rostitutes.  of  which  a  very 
large  number  is  venereally  infected,  attempt  the  regulation  of 
prostitution?  According  to  so  great  an  authority  as  Fournier 
of  Paris,  regulation  and  sanitary  supervision  are  of  little  avail. 
On  the  other  hand,  according  to  Bierhoff,  an  A.merican  author- 
ity on  the  subject,  they  have  been  most  successful  in  reducing 
venereal  morbidity  and  mortality  in  Dresden.  Neither  regula- 
tion nor  sanitary  supervision,  nor  their  absence,  nor  their  aban- 
donment are  new  conceptions  of  the  problem.  lUit  the  results 
obtained  and  tabulated  in  the  Hygiene  Exposition  of  Dresden 
(1911)  must  give  one  food  for  thought,  and,  because  of  our 
present  state  of  civilization,  and  the  fearful  i)revalence  of 
venereal  disease,  and  its  terrible  consequences  to  the  health 
of  our  nation,  they  make  me  look  a  little  more  favorably  upon 
the  Dresden  method."     And  to  further  quote  Professor  Knopff": 

"The  Municipal  Clinic  of  San  Francisco  is  trying,  as  an 
experiment,  a  method  similar  to  the  one  in  vogue  in  Dresden 
and  claims  good  results,  particularly  because  it  combines 
medical  and  sociological  work.  For  further  details  of  this 
difficult  subject,  I  refer  mv  readers  to  Dr.  Roscnstirn's  com- 
munication to  the  I^fteenth  Congress  on  Hygiene  and   Dcuio- 

47 


i^raphv ,  ami  to  three  most  a(lmiral)k'  articles  hy  Dr.  l-'reilerick 
IWerhotY  of  Xcw  York. 

"There  is  not  the  siii^htesl  tlouht  in  my  miiul  that  lhroUL;h 
riiiiil  exaininatioii  ami  the  treatment  of  tliscovered  cases,  many 
centers  of  infection  will  cease  to  exist  and  the  morbidity  and, 
mortality  from  syphilis  and  gonorrhtiea  will  be  very  materially 
decreased. 

"I  would  wish  to  add  that  all  this  should  be  done  in  a  most 
huniane  manner  with  no  intention  tn  ]nmish.  liut  to  cm-e  and 
to  redeem." 

I'"or  fully  two  years  before  these  words  of  Professor  Knopff's 
were  written,  the  Municipal  Clinic  of  San  bVancisco,  as  the  first 
anywhere,  had  inau_!.;urated  and  ])racticed  the  principles  of  a 
humane  and  kimll\-  tolerant  sanitary  regulation  of  the  social 
malady. 

We  not  only  succeeded  in  bringing  about  great  smiifary  im- 
proi'CDieiits  but  also  achieved  some  remarkably  good  sociological 
results,  because  we  freed  the  sanitary  control  of  these  women 
from  all  the  past  and  present  criminality  attached  to  other 
svstems,  and  met  them  in  a  humane  and  sympathetic  spirit  at  the 
Clinic. 

While  we  do  not  approve  of  methods  of  criminal  regulation 
heretofore  exercised  in  various  countries,  with  house  examina- 
tions of  dubious  value  as  to  their  impartiality  and  scientific 
reliability,  even  these  have  shown  great  results  for  the  sanita- 
tion of  the  different  European  armies.  They  offer  an  ideal 
material  for  statistical  comparison,  soldiers  being  all  men  of 
about  the  same  age,  of  similar  physical  and  mental  caliber,  and 
living  under  similar  conditions  as  to  food  and  occupation. 
Germany,  with  her  strict  regulation,  shows,  during  a  period  of 
twenty  years,  only  38  per  thousand  annual  admissions  to  hos- 
pitals for  infections  with  venereal  diseases ;  Prussia  alone  only 
18;  while  Great  Britain,  with  no  regulation,  showed  about  225 
to  250  per  thousand. 

The  above  results  in  the  armies  of  European  countries, 
where  sanitary  control  of  the  social  malady  prevails,  were  at- 
tained even  before  the  present  thorough  microscopical  and 
bacteriological  methods  of  examination  had  been  introduced. 

Our  own  American  army  has  until  recently  shown  similar 
unsanitary  conditions  to  the  British,  as  presented  in  Secretary 
Stimson's  report.  The  English  act  for  sanitary  regulation  was 
reyoked  through  an  agitation  of  just  such  people  as  oppose 
sanitary  measures  here.  In  the  face  of  the  findings  of  two 
specially  appointed  and  fitted  commissions,  both  reporting  in 
favor  of  its  continuance  on  account  of  excellent  results  during 

48 


Its.  short-lived  existence.  Parliament  abolished  these  sanitary 
measures,  foolishly  yielding-  to  hysterical  outcries.  Ever  since 
sorrow  has  been  theirs,  and  the  terrible  results  in  their  Indian 
army  have  led,  for  this  continij^ent  at  least,  to  the  resurrection 
of  sanitary  regulation  in  garrison  posts. 

The  great  International  Medical  Congress,  which  met  in 
London  less  than  a  month  ago  (July,  1913),  discussed  the  ter- 
rible danger  threatening  the  health  of  the  nations  from  the 
poison  of  venereal  diseases.  Strong  resolutions  were  passed 
endorsing  the  principles  of  the  Clinic's  work. 

In  his  memorable  address  before  the  bodv  of  the  Congress, 
the  great  army  surgeon,  Major  H.  C.  French.  R.  A.  M.  C, 
stated,  as  an  instance  of  the  beneficial  effect  of  state  control, 
that  these  measures  adopted  in  1900.  had,  in  the  last  thirteen 
years,  reduced  by  over  two-thirds  the  proportion  of  soldiers 
admitted  to  hospitals  suffering  from  venereal  diseases.  He 
earnestly  hoped  that  definite  resolutions  might  be  drawn  up 
by  the  Congress  and  a  serious  attempt  made  to  ensure  legis- 
lative control  of  the  disease,  apart  from  the  state  regulation  of 
vice. 

His  conclusions  are  pre-eminently  authoritative,  being  the 
outcome  of  many  years  of  most  exact  and  painstaking  military 
observation  of  an  entirely  unobjectionable  material;  a  large 
body  of  soldiers  of  unchanging  physical  characteristics,  spread 
over  an  enormous  area  and  subject  to  unvarying  conditions  of 
life.  In  its  freedom  from  any  vitiating  influence  this  experi- 
ment on  the  largest  scale  furnishes  in  a  satisfactory  manner 
all  the  points  of  a  quasi  mathematical  proof  that  can 'reason- 
ably be  demanded. 

Based  upon  this  long  and  enormous  experience  and  the 
brilliant  results  obtained  by  the  sanitary  control  employed, 
Major  French  recommended  the  following  measures,  sum- 
marizing them  under  three  headings : 

"First.  Control  at  the  source  which  is  concerned  with  pros- 
titution before  disease  is  contracted  or  spread.  This  embraces : 
(a)  medical  notification  of  disease;  (b)  suppression  of  souteneurs 
and  public  solicitation  in  the  streets;  (c)  protection  of  orphans 
and  destitute  children;  (d)  police  measures. 

"Secondly.  Prevention  by  medical  measures,  i.  e..  prophy- 
laxis by  treatment  after  disease  has  been  contracted.  This 
includes:  fa)  provision  of  hospital  beds  and  segregation;  (b) 
professorships  at  large  hospitals;  (c)  instruction  of  students 
and  the  public;  (d)  treatment. 

"Thirdly.     Moral    and-  religious    considerations.      These    are 

49 


placcil  last  hut  hy  lui  means  least,  ami  arc  more  applicable  to 
NDUth  ami  adolescence  before  disease  is  contracted." 

In  conclusion.  Major  i'^rencb  ((noted  from  Lecky's  "History 
oi  luiro])ean  Morals,"  in  wbicli'tbat  writer  deplores  the  fact 
that  an  epiilemic  which  is  one  of  the  most  dreadful  now  exist- 
ing' amongst  mankind,  which  communicates  itself  from  the 
iiuilty  to  the  innocent,  should  be  sutl'ered  to  rage  unchecked 
because  the  legislature  refuses  to  take  official  cognizance  of 
its  existence  or  proper  sanitary  measures  for  its  repression. 

The  Congress,  by  a  large  majority,  adopted  the  official 
resolutions,  wherein  it  was  recommended  among  other  items, 
that  the  governments  of  all  countries  there  represented,  be 
called  upon  to  institute  a  system  of  confidential  notification  of 
the  disease  to  a  sanitary  authority  wherever  such  notification 
does  not  already  obtain,  and  to  make  systematic  provision  for 
the  diagnosis  and  treatment  of  all  cases  not  otherwise  pro- 
vided for. 

A  general  expression,  however,  from  the  members  of  this 
Congress  as  to  the  necessity  of  combined  energetic  action 
against  the  spread  of  venereal  diseases  did  not  appear  suf- 
ficiently mandatory  to  the  heads  of  the  British  medical  pro- 
fession. They  realized  that  their  own  country  required  a  more 
stirring  appeal,  and  voiced  their  judgment  as  to  the  great  and 
immediate  need  of  the  British  people  for  a  thorough  investiga- 
tion of  the  poisoning  of  the  nation  with  a  continuous  inflow  of 
venereal  diseases  and  for  the  adoption  of  measures  to  stem 
this  noxious  current,  in  the  following  letter  to  the  English 
press:. 

(Extract   from   the   Morning  Post,  July  22,    1913) 

THE  PUBLIC  HEALTH 
Doctors'  Demand  for  a  Royal  Commission 

To  the  Editor  of  the  IMorning  Post,  Sir:  The  increase  in  medical 
knowledge  during  the  last  sixt}'  years  has  been  extremely  rapid  and 
the  control  of  health  problems  by  the  state  and  municipalities  has 
become  one  of  the  most  striking  features  of  modern  civilization.  The 
state  has  compelled  local  authorities  to  build  asylums  for  the  insane; 
it  has  encouraged  them  to  make  provision  for  the  segregation  of  cases 
of  infectious  fevers;  it  has  insisted  on  the  notification  of  many  in- 
fectious diseases;  it  has  undertaken  the  inspection  of  children  on  a 
colossal  scale;  it  has  introduced  an  elaborate  machinery  to_ ensure  the 
purity  of  foods,  and  it  is  steadily  at  work  laboriously  building  up  a 
vast  system  of  public  health  legislation.  Today  we  are  all  looking 
forward  to  what  may  be  the  effects  of  the  campaign  against  tubercu- 
losis, and  the  community  has  cause  to  congratulate  itself  on  the 
organized  national  effort  that  it  is  about  to  make  to  eliminate  the 
disease. 

In  all  this  organized  effort  there  is  one  noteworthy  omission. 
There  has  always  been  a   conspiracy  of  silence  as  regards  venereal 

50 


diseases.  The  time,  however,  has  come  when  it  is  a  national  duty  to 
face  the  facts  and  to  bring  them  prominently  to  the  notice  of  the 
public. 

When  the  subject  was  discussed  last  year  at  the  Royal  Society 
of  Medicine  it  was  stated  without  contradiction  that  in  London  alone 
there  are  forty  thousand  new  cases  of  the  gravest  form  of  the  disease 
every  year,  and  in  the  United  Kingdom  as  a  whole  a  hundred  and 
thirty  thousand  such  cases.  The  worst  form  of  venereal  disease  is 
highly  contagious  and  dire  in  its  efifects.  It  claims  its  victims  not  only 
from  those  who  have  themselves  to  blame  for  contracting  it;  it  is  one 
of  those  diseases  that  may  be  transferable  from  parent  to'child,  so  that 
the  offspring  of  a  sufferer  is  born  with  the  virus  actually  in  its  tissues, 
to  cause,  it  may  be,  hideous  deformity,  or  blindness,  or  deafness,  or 
idiocy,  ending  often  in  premature  though  not  untimely  death.  Inno- 
cent members  of  the  public,  wives,  children,  doctors,  dentists,  students 
and  nurses,  are  among  those  who,  during  the  routine  of  their  daily 
life,  are  often  accidentally  called  upon  to  pay  a  tragic  penalty  for  the 
wilful  blindness  that  ignores  its  existence.  There  is  a  great  volume 
of  evidence  that  locomotor  ataxia  and  general  paralysis  are  its  belated 
manifestations. 

We  are  living  today  in  a  new  era  as  regards  diagnosis  and  treat- 
ment. The  microbes  responsible  for  these  diseases  have  been  dis- 
covered in  recent  years;  means  of  diagnosis  far  in  advance  of  previous 
experience  have  been  elaborated  and  treatment  has  been  enormously 
improved.  The  time  is,  therefore,  appropriate  for  an  organized  effort 
on  a  comprehensive  scale  to  reduce  the  incidence  of  these  diseases. 
The  experience  of  the  Royal  Army  Medical  Corps  during  the  last 
few  years  has  shown  the  enormous  reduction  in  all  forms  of  the  dis- 
ease that  can  be  brought  about  as  a  result  of  systematic  effort. 

Organized  effort  among  the  civilian  population  is  impracticable 
until  the  public  conscience  has  been  aroused,  and  can  only  be  at- 
tempted after  a  full  and  authoritative  investigation.  We  appeal,  there- 
fore, to  the  public  through  your  columns  to  demand  the  appointment 
of  a  Royal  Commission — its  members  to  include  a  substantial  majority 
of  medical  men — to  investigate  the  facts  and  to  recommend  what 
steps,  prophylactic  and  thernpeutic,  should  be  taken  to  cope  with 
these  diseases. 

Yours,  etc., 

THOMAS  BARLOW, 

President    of   the   Royal    College   of    riiysici.ins 
of    London. 

RICKMAN   J.    GODLEE, 

President    of    the    Royal    College    <il     Smmoiis 
of  England. 
WILLIAM  OSLER, 

Regius    Professor    of    Medicine    at    llu-    I'liiviT- 
sity   of   Oxford. 

T.   CLIFFORD  ALLBUTT. 

Regius    Professor    of    Medicinf    .il    llu-    I'liiver- 
sity    of    Cambridge. 

JAMES    LITTLE, 

Regius    Professor   of    Pliysic   at    llie    riiivirsily 
of   Dul)lin. 

FRANCIS   H.   CHAM  PN  FYS. 

President    of    the    Royal    Society    of    Medicine. 

W.   WATSON    CHEYNE, 

President    of   the    Medical    Society    of    Lcndmi. 

51 


W.   S.   CHURCH. 

■  'resident  of  tlu-  Kov.il  College  of  Physicians 
of    KnK'land,    1899-1905. 

JOHN   TVVKKDV. 

I'resi.leiit  of  the  Uoyal  College  of  KnKlan.l, 
1903-190(,.  ^ 

HENRY   MORRIS. 

President  of  the  Koyal  College  of  Surgeons 
of  Kngland.  1906-1909.  and  immediate  Past 
President   of  the    Royal    Society   of   Medicine. 

.1.    .MITCH  RLL   BRUCE. 

I. .lie  President  of  the  Medical  Society  of 
London. 

JAMES   BARR, 

President    of    the    British    Medical    .Xssociatitin. 

ROBERT   H.  WOODS, 

President    of    the    Irish    Medical    .\ssociatioii. 

E.  B.  TURNER. 

Deputy  Chairman  of  Kcpresentative  Meetings 
of    tile    British     Medical     .\ssociation. 

W.  p.  H  ERR  INCH  AM. 

Vice-Chancellor   of    the    University    of    London. 

F.  W.  MOTT, 

Pathologist    to    the    London    County    Asylums. 

CHARLES  J.  MARTIN. 

Director  of  the  Lister  Institute  of  Preventive 
Medicine. 

B.  BARRETT  HAM. 

Late  Chief  Medical  Ofificer  for  Victoria  and 
Commissioner  of  Public  Health  for  Queens- 
land. 

JOHN    BLAND-SUTTON. 

Surgeon    to    the    Middlesex    Hospital. 

JOHN  ROSE  BRADFORD, 

Physician     to     I'niversity     College     Hospital. 

JOHN   COLLIE, 

Medical  Kxaminer  to  the  London  County 
Council,  late  Home  Ofifice  Medical  Referee 
Workmen's    Compensation    Act. 

ANDERSON  CRITCHETT, 

Consulting  Opthalmic  Surgeon  to  St.  Mary's 
Hospital,  late  President  of  the  Opthalmo- 
logical    Society. 

ALFRED   PEARCE  GOULD. 

Dean  of  the  Faculty  of  Medicine  of  the 
L'niversity    of    London. 

VICTOR   A.   H.   HORSLEY, 

Surgeon  to  the  National  Hospital  for  Para- 
lyzed   and    Epilei)tic. 

MALCOLM    MORRIS, 

Surgeon  to  the  Skin  Department  of  the  Sea- 
men's   Hospital. 

GEORGE  H.   SAVAGE, 

Consulting  Physician  for  Mental  Diseases  to 
Guy's    Hospital. 

T.   W.   GIBBARD, 

Military    Hospital,    Rochester. 

W.   McADAM   ECCLES, 

Surgeon   to   St.    Bartholomew's   Hospital. 

JONATHAN    HUTCHINSON. 

Surgeon    to    the    London    Hospital. 

52 


J.   ERNEST  LANE, 

Senior  Surgeon  to  the  London   Lock  Hospital. 

J.  E.  R.  McDONAGH, 

Surgeon  to  the  London   Lock  Hospital. 

G.  H.  MAKINS, 

Surgeon    to    St.    Thomas'    Hospital. 

GEORGE   R.   MURRAY, 

Professor  of  Systematic  Medicine  at  the  Vic- 
toria   University    of    Manchester. 

D'ARCY    POWER, 

Surgeon     to     St.     Bartholomews     Hospital. 

THOMAS   SINCLAIR, 

Surgeon    to   the    Belfast   Royal    Hospital. 

CHARLES  J.   SYMONDS, 

Consulting  Surgeon  to  Guy's  Hospital,  Presi- 
dent-elect of  the  Clinical  Section  of  the  Royal 
Society  of  Medicine,  late  Professor  of  the 
Medical  Society  of  London,  and  Member  of 
the  Council  of  the  Royal  College  of  Sur- 
geons   of    England. 

NORMAN  WALKER, 

Physician  for  Diseases  of  the  Skin,  the  Royal 
Infirmary   of    Edinburgh. 

MARY  SCHARLIEB, 

Consulting  Physician  for  Diseases  of  Women 
to    the    Royal    Free    Hospital. 

On  August  11th,  1913,  in  the  British  House  of  Commons,  in 
answer  to  questions  from  Drs.  Esmonde  and  Chappie  regard- 
ing the  appointment  of  a  Royal  Commission  to  inquire  into 
the  causes  and  treatment  of  venereal  diseases,  Premier  As- 
quith  replied :  "The  Government  have  agreed  to  institute  an 
inquiry.  Its  precise  terms  and  scope  and  the  character  and 
composition  of  the  body  to  be  set  up,  are  still  under  consider- 
ation." 

Nearly  thirty-five  years  have  passed  since  the  reports  of 
the  two  Royal  Commissions  were  disregarded  by  the  British 
Parliament.  Venereal  diseases  have  had  free  and  unhindered 
scope  through  the  British  Isles  and  most  of  its  colonies  during  that 
time.  The  terrible  ravages  wrought  during  these  many  years  have 
at  last  forced  the  nation's  attention  again  upon  this  long  neglected 
burning  question  of  the  social  malady  and  the  adoption  of 
measures  and  regulations  to  halt  its  infliction  with  irremediable 
injuries  to  the  people's  health. 

Shall  we  also  wait  another  thirty-live  years  until  our  con- 
science is  at  last  awakened  by  more  and  more  untold  misery 
that  could  have  been  prevented  by  the  timely 'issuance  of 
humane  and  rational  sanitary  regulations? 

The  absence  of  regulation  for  prostitution  not  only  leaves 
the  door  wide  open  to  foul  disease,  but  just  so  surely  as  wide 
open  to  graft,  police  graft  of  the  worst  kind.  Wherever  vice 
commissions  have  uncovered  the  sinkpools  of  the  underworld, 

53 


the  easier  .^rat't  of  tlio  police  upon  tlu-sc  IiuiiUhI  woincii,  and 
their  slock  keepers  and  protectors,  has  been  one  of  the  most 
ajipallin^-  and  repellinj;-  features.  We  had  i)ractically  no  street 
walkers  in  this  city  during-  the  more  than  two  years'  life  of  the 
Clinic.  Now,  since  the  removal  of  the  jxilice  surveillance,  they 
hci^in  to  stealthily  re-enter  the  nightlife  of  the  citv's  thor- 
oughfares. 

It  may  be  justly  said  that  auth(iritati\'e  reglementation  of 
the  sex  traffic  is  nc)t  new.  that  in  a  nund)er  of  European  coun- 
tries it  has  been  practiced  for  many  decades  with  more  or  less 
gratifying-  success.  Our  system  is  most  thorough  and  modern 
in  a  scientific  sense ;  our  clinical  examinations  and  laboratory 
tests  are  fully  up  to  date ;  no  house  examinations  with  their 
corrupting  temptations  are  permitted;  but  no  claim  for  a  true 
forward  reformatory  step  can  be  based  on  that  alone. 

In  our  treatment  of  this  problem  the  part  of  the  persecutor 
is  entirely  banished  from  the  Clinic.  We  tried,  and  succeeded, 
to  impress  upon  these  unfortunate  beings,  our  clients,  that  we 
are  their  friends  and  they  our  private  patients;  that,  in  our 
efforts  to  protect  public  health,  we  are  also  shielding  their 
own.  They  have  learned  to  realize  that  a  strict  compliance 
with  the  sanitary  rules  of  the  Clinic  is  for  their  best  personal 
benefit  in  a  physical  as  w'ell  as  a  general  sense,  through  its 
protection  against  graft. 

This  humane  and  sympathetic  attitude  taken  by  the  Clinic 
toward  its  unfortunate  and  pitiable  clients  constitutes,  in  the 
opinion  of  the  Advisory  Committee,  the  main  distinguishing 
feature  from  all  other  efforts  and  systems  of  sanitary  regie- 
mentation,  an  indispensable  one  for  the  insurance  of  success. 

Our  work  lies  within  strictly  sanitar}^  limits.  This  I 
have  tried  to  accentuate  in  these  pages.  We  have  to  deal  with 
an  existing  evil  which  has  successfully  resisted,  since  long  be- 
fore the  beginning  of  even  the  world's  traditional  history,  all 
efforts  toward  eradication.  Punishment,  with  all  degrees  of 
severity,  the  brand  of  public  shame  and  ostracism,  have  failed 
to  thin  the  ranks  of  its  votaries.  Persecution  drives  them  from 
the  open,  back  to  darkest  haunts  into  which  only  scant  rays  of  light 
can  penetrate,  and  from  wdience  the  disease-bearing  shafts 
fly  out  more  poisonous  and  in  even  greater  numbers.  Bright, 
radiant  light  is  here,  and  everywhere,  the  prime  factor  for  the 
gain  of  appreciative  knowledge,  the  first  condition  for  effective 
help, 

A  modern  spirit  of  social  research,  more  just  because  more 
thorough,   more   forgiving   becatise    more    understanding,   has 

54 


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